{"hospital_name":"Lexington Medical Center","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["Lexington Medical Center"],"hospital_address":["2720 Sunset Blvd, West Columbia, SC 29169"],"license_information":{"license_number":"HTL-0960","state":"SC"},"type_2_npi":["1144248097","1356366314","1689282733","1386241834","1114297066","1932449014","1831550060"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Jeff Brillhart"},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"AARP","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Preferred Blue All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"State All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BlueChoice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BlueChoice","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Choice Care PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"MedCost","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum VA CCN","plan_name":"Other NonCommercial","description":"The modified price is presented in the standard charge value."},{"payer_name":"PHCS","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prime Healthcare","plan_name":"First Choice VIP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Marketplace Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"CHLORAMPHENICOL SOD SUCCINATE 1 G IV SOLR [25518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-011-15","type":"NDC"}],"standard_charges":[{"gross_charge":208.86,"discounted_cash":208.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROXYZINE HCL 25 MG PO TABS [3774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-486-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG/5ML PO SYRP [3771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-750-47","type":"NDC"}],"standard_charges":[{"gross_charge":30.79,"discounted_cash":30.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":76.95,"discounted_cash":76.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":153.9,"discounted_cash":153.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG/5ML PO SYRP [3771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-502-47","type":"NDC"}],"standard_charges":[{"gross_charge":27.99,"discounted_cash":27.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":69.98,"discounted_cash":69.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":139.95,"discounted_cash":139.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG/5ML PO SYRP [3771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-502-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":20.1,"discounted_cash":20.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG PO TABS [3772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-500-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 50 MG/ML IM SOLN [3770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-5601-01","type":"NDC"}],"standard_charges":[{"gross_charge":308.41,"discounted_cash":308.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":154.21,"discounted_cash":154.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 50 MG/ML IM SOLN [3770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-5601-25","type":"NDC"}],"standard_charges":[{"gross_charge":308.41,"discounted_cash":308.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":154.21,"discounted_cash":154.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE PAMOATE 25 MG PO CAPS [3777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-696-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE PAMOATE 25 MG PO CAPS [3777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"14539-674-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE PAMOATE 25 MG PO CAPS [3777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7065-61","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE PAMOATE 25 MG PO CAPS [3777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1803-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 50 MG/ML IM SOLN [3770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-5602-25","type":"NDC"}],"standard_charges":[{"gross_charge":197.97,"discounted_cash":197.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.99,"discounted_cash":98.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG PO TABS [3772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-081-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE HCL 10 MG PO TABS [3772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYPROGESTERONE CAPROATE 250 MG/ML IM OIL [108013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"69238-1797-1","type":"NDC"}],"standard_charges":[{"gross_charge":4187.86,"discounted_cash":4187.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYPROGESTERONE CAPROATE 250 MG/ML IM OIL [108013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"67457-967-01","type":"NDC"}],"standard_charges":[{"gross_charge":4148.44,"discounted_cash":4148.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYPROGESTERONE CAPROATE 250 MG/ML IM OIL [108013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"64011-247-02","type":"NDC"}],"standard_charges":[{"gross_charge":3997.44,"discounted_cash":3997.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYPROGESTERONE CAPROATE 250 MG/ML IM OIL [108013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"55150-309-01","type":"NDC"}],"standard_charges":[{"gross_charge":5283.37,"discounted_cash":5283.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYETHYL STARCH IN NACL 6-0.9 % IV SOLN [92837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1029-02","type":"NDC"}],"standard_charges":[{"gross_charge":364.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":364.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 25 MG/ML ORAL SUSPENSION [40810235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-753-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS [10235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-144-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"HYDROXOCOBALAMIN ACETATE 1000 MCG/ML IM SOLN [138024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3425","type":"HCPCS"},{"code":"0591-2888-30","type":"NDC"}],"standard_charges":[{"gross_charge":164.68,"discounted_cash":164.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROXOCOBALAMIN 5 G IV SOLR [111437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"50633-310-11","type":"NDC"}],"standard_charges":[{"gross_charge":5926.01,"discounted_cash":5926.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"HYDROMORPHONE HCL-NACL 50-0.9 MG/50ML-% IV SOLN [131594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"9999-2634-50","type":"NDC"}],"standard_charges":[{"gross_charge":270.1,"discounted_cash":270.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROMORPHONE HCL-NACL 50-0.9 MG/50ML-% IV SOLN [131594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092-1546-35","type":"NDC"}],"standard_charges":[{"gross_charge":159.14,"discounted_cash":159.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN [93106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-0018-01","type":"NDC"}],"standard_charges":[{"gross_charge":387.4,"discounted_cash":387.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROXYPROGESTERONE CAPROATE 250 MG/ML IM OIL [108013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"71225-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":2040.2,"discounted_cash":2040.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYZINE PAMOATE 25 MG PO CAPS [3777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-696-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYPROGESTERONE CAPROATE 250 MG/ML IM OIL [108013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"71225-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":642.67,"discounted_cash":642.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROXYUREA 100 MG/ML ORAL SOLN [40810236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-999-11","type":"NDC"}],"standard_charges":[{"gross_charge":2676.44,"discounted_cash":2676.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"HYDROXYZINE HCL 10 MG PO TABS [3772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5060-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYUREA 500 MG PO CAPS [10236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-284-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"HYDROXYUREA 500 MG PO CAPS [10236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"HYDROXYUREA 500 MG PO CAPS [10236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-724-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"HYDROXYUREA 500 MG PO CAPS [10236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0882-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"HYDROXYUREA 100 MG/ML ORAL SOLN [40810236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-999-13","type":"NDC"}],"standard_charges":[{"gross_charge":585.7,"discounted_cash":585.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 ML"}]},{"description":"HYDROXYUREA 100 MG/ML ORAL SOLN [40810236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-999-12","type":"NDC"}],"standard_charges":[{"gross_charge":869.66,"discounted_cash":869.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 105 ML"}]},{"description":"HYDROXYPROGESTERONE CAPROATE 275 MG/1.1ML SC SOAJ [134577]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1726","type":"HCPCS"},{"code":"64011-301-03","type":"NDC"}],"standard_charges":[{"gross_charge":5180.26,"discounted_cash":5180.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 275 MG"}]},{"description":"HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN [93106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2634-50","type":"NDC"}],"standard_charges":[{"gross_charge":631.6,"discounted_cash":631.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYDROXYZINE PAMOATE 25 MG PO CAPS [3777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-847-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IBUPROFEN 400 MG PO TABS [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0440-7626-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 200 MG PO TABS [3841]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-941-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 200 MG PO TABS [3841]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7914-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-6003-28","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-503-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1828-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN 400 MG PO TABS [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5853-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG PO TABS [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-457-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG PO TABS [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-457-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 600 MG PO TABS [3844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-361-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 400 MG PO TABS [3843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71335-0458-9","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 100 MG/5ML PO SUSP [10246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1828-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN [110306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-524-33","type":"NDC"}],"standard_charges":[{"gross_charge":1489.74,"discounted_cash":1489.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN [110306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-191-83","type":"NDC"}],"standard_charges":[{"gross_charge":254.92,"discounted_cash":254.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"HYPROMELLOSE 0.3 % OP GEL [91018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77790-002-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.78,"discounted_cash":42.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG PO TBDP [29822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43199-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG PO TBDP [29822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192-338-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"HYLAN G-F 20 48 MG/6ML IX SOSY [125057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468-0090-3","type":"NDC"}],"standard_charges":[{"gross_charge":4120.33,"discounted_cash":4120.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"HYLAN G-F 20 16 MG/2ML IX SOSY [125056]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468-0090-2","type":"NDC"}],"standard_charges":[{"gross_charge":2747.08,"discounted_cash":2747.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HYLAN G-F 20 16 MG/2ML IX SOSY [125056]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468-0090-1","type":"NDC"}],"standard_charges":[{"gross_charge":2747.08,"discounted_cash":2747.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HYDROXYZINE PAMOATE 50 MG PO CAPS [3778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1804-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROXYZINE PAMOATE 25 MG PO CAPS [3777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-847-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG PO TBDP [29822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70156-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG SL SUBL [17023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42192-339-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"HYPROMELLOSE 0.3 % OP GEL [91018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-8064-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.3,"discounted_cash":42.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"HYPERLYTE-CR IV CONC [142492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-1943-20","type":"NDC"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36 ML"},{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"},{"gross_charge":121.0,"discounted_cash":121.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"HYOSCYAMINE SULFATE ER 0.375 MG PO TB12 [17010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51525-0115-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.375 MG"}]},{"description":"HYOSCYAMINE SULFATE 0.5 MG/ML IJ SOLN [10239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-111-05","type":"NDC"}],"standard_charges":[{"gross_charge":257.12,"discounted_cash":257.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":514.23,"discounted_cash":514.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"HYOSCYAMINE SULFATE 0.5 MG/ML IJ SOLN [10239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":199.78,"discounted_cash":199.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":399.56,"discounted_cash":399.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"HYOSCYAMINE SULFATE 0.5 MG/ML IJ SOLN [10239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0037-9001-05","type":"NDC"}],"standard_charges":[{"gross_charge":199.4,"discounted_cash":199.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":398.79,"discounted_cash":398.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG SL SUBL [17023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43199-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN [118158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"17478-540-05","type":"NDC"}],"standard_charges":[{"gross_charge":64.12,"discounted_cash":64.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE HCL PF 2 MG/ML IJ SOLN [117476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323-853-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN [117478]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-851-15","type":"NDC"}],"standard_charges":[{"gross_charge":97.45,"discounted_cash":97.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-17","type":"NDC"}],"standard_charges":[{"gross_charge":43.83,"discounted_cash":43.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":87.66,"discounted_cash":87.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1283-17","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROCORT-PRAMOXINE (PERIANAL) 1-1 % EX FOAM [142558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0037-6822-10","type":"NDC"}],"standard_charges":[{"gross_charge":1149.3,"discounted_cash":1149.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 500 MG IJ SOLR [148871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0016-12","type":"NDC"}],"standard_charges":[{"gross_charge":521.4,"discounted_cash":521.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR [148869]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0013-06","type":"NDC"}],"standard_charges":[{"gross_charge":125.04,"discounted_cash":125.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":250.08,"discounted_cash":250.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR [148869]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0013-05","type":"NDC"}],"standard_charges":[{"gross_charge":137.15,"discounted_cash":137.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":274.29,"discounted_cash":274.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 1000 MG IJ SOLR [148870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1720","type":"HCPCS"},{"code":"0009-0005-01","type":"NDC"}],"standard_charges":[{"gross_charge":1018.95,"discounted_cash":1018.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR [148868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69097-004-67","type":"NDC"}],"standard_charges":[{"gross_charge":108.27,"discounted_cash":108.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":54.14,"discounted_cash":54.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1283-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-2552-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2552-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-1283-37","type":"NDC"}],"standard_charges":[{"gross_charge":91.04,"discounted_cash":91.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":45.52,"discounted_cash":45.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1283-37","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR [148868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0011-04","type":"NDC"}],"standard_charges":[{"gross_charge":150.67,"discounted_cash":150.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":150.67,"discounted_cash":150.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR [148868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0011-03","type":"NDC"}],"standard_charges":[{"gross_charge":159.06,"discounted_cash":159.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":159.06,"discounted_cash":159.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCORTISONE 1 % EX CREA [3726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7623-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA [3726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0343-56","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA [3726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0321-26","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"HYDROCORTISONE 1 % EX CREA [3726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0015-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 G"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA [142530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-431-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999302310","type":"NDC"}],"standard_charges":[{"gross_charge":36.6,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":36.6,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-417-44","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN [37848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-2316-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [34544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-407-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [34544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-407-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCORTISONE 1 % EX CREA [3726]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-438-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2552-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROCORTISONE 10 MG PO TABS [3733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0074-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCORTISONE N/A POWD [3735]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"38779-0009-4","type":"NDC"}],"standard_charges":[{"gross_charge":404.85,"discounted_cash":404.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"HYDROCORTISONE MICRONIZED N/A POWD [10217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0574-0420-25","type":"NDC"}],"standard_charges":[{"gross_charge":429.45,"discounted_cash":429.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-341-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-341-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-341-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-301-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.21,"discounted_cash":21.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":42.41,"discounted_cash":42.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-676-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7090-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCORTISONE 100 MG/60ML RE ENEM [10210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-111-07","type":"NDC"}],"standard_charges":[{"gross_charge":112.35,"discounted_cash":112.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-2552-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN WR [4080090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6151-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN WR [4080090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-6151-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN WR [4080090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0641-6151-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN WR [4080090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6151-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL PF 2 MG/ML IJ SOLN [117476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-853-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN [117478]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-851-07","type":"NDC"}],"standard_charges":[{"gross_charge":128.14,"discounted_cash":128.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN [117478]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2634-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL PCA 1 MG/ML PREMIX WRAPPER [4080069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"9999-9999-04","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE HCL PCA 1 MG/ML PREMIX WRAPPER [4080069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"69374-983-30","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE HCL PCA 1 MG/ML PREMIX WRAPPER [4080069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"69374-559-30","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN WR [4080090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"63323-853-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN WR [4080090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-853-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IV SOLN [147296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"71266-9115-1","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-4264-11","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4264-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"0409-4264-01","type":"NDC"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN WR [4080081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4264-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-3243-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-579-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"HYDROMORPHONE HCL 2 MG PO TABS [3760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-301-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"IBUPROFEN 800 MG PO TABS [3845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5855-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IOPAMIDOL 76 % IV SOLN BULK [4082010328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-1316-95","type":"NDC"}],"standard_charges":[{"gross_charge":86.6,"discounted_cash":86.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":99.59,"discounted_cash":99.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 115 ML"},{"gross_charge":108.25,"discounted_cash":108.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"},{"gross_charge":121.24,"discounted_cash":121.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":129.9,"discounted_cash":129.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":64.95,"discounted_cash":64.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"},{"gross_charge":73.61,"discounted_cash":73.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 ML"}]},{"description":"IOPAMIDOL 76 % IV SOLN [10328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-1316-35","type":"NDC"}],"standard_charges":[{"gross_charge":121.6,"discounted_cash":121.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":139.84,"discounted_cash":139.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 115 ML"},{"gross_charge":152.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"},{"gross_charge":170.24,"discounted_cash":170.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":182.4,"discounted_cash":182.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":91.2,"discounted_cash":91.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"},{"gross_charge":103.36,"discounted_cash":103.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 17.2 % UR SOLN [10330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0019-0862-50","type":"NDC"}],"standard_charges":[{"gross_charge":139.5,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 60 % IJ SOLN [10333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0019-0953-05","type":"NDC"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":173.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":259.5,"discounted_cash":259.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":51.9,"discounted_cash":51.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":86.5,"discounted_cash":86.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 68 % IJ SOLN [137287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0019-1323-11","type":"NDC"}],"standard_charges":[{"gross_charge":131.8,"discounted_cash":131.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":164.75,"discounted_cash":164.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"},{"gross_charge":197.7,"discounted_cash":197.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":263.6,"discounted_cash":263.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":65.9,"discounted_cash":65.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 68 % IJ SOLN [137287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0019-1323-06","type":"NDC"}],"standard_charges":[{"gross_charge":156.8,"discounted_cash":156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"},{"gross_charge":235.2,"discounted_cash":235.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":313.6,"discounted_cash":313.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":47.04,"discounted_cash":47.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":78.4,"discounted_cash":78.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOTHALAMATE MEGLUMINE 60 % IJ SOLN [10333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0019-0953-23","type":"NDC"}],"standard_charges":[{"gross_charge":325.74,"discounted_cash":325.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":488.6,"discounted_cash":488.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":97.72,"discounted_cash":97.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":162.87,"discounted_cash":162.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOPAMIDOL 61 % IV SOLN [27737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-1315-35","type":"NDC"}],"standard_charges":[{"gross_charge":101.2,"discounted_cash":101.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":151.8,"discounted_cash":151.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":50.6,"discounted_cash":50.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 180 MG/ML IJ SOLN [10319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1411-10","type":"NDC"}],"standard_charges":[{"gross_charge":2617.6,"discounted_cash":2617.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":3926.4,"discounted_cash":3926.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":1308.8,"discounted_cash":1308.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-50","type":"NDC"}],"standard_charges":[{"gross_charge":193.67,"discounted_cash":193.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":290.5,"discounted_cash":290.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":96.84,"discounted_cash":96.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-10","type":"NDC"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":303.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN [17595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-383-05","type":"NDC"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":340.5,"discounted_cash":340.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":113.5,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IODINE TINCTURE EX TINC [114848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0395-1213-16","type":"NDC"}],"standard_charges":[{"gross_charge":93.84,"discounted_cash":93.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"IODINE STRONG 5 % PO SOLN [3961]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"48433-230-15","type":"NDC"}],"standard_charges":[{"gross_charge":202.95,"discounted_cash":202.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"},{"gross_charge":202.95,"discounted_cash":202.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":202.95,"discounted_cash":202.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 DROP"},{"gross_charge":202.95,"discounted_cash":202.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 DROP"},{"gross_charge":202.95,"discounted_cash":202.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 DROP"},{"gross_charge":202.95,"discounted_cash":202.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 DROP"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN [120080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1412-10","type":"NDC"}],"standard_charges":[{"gross_charge":2824.6,"discounted_cash":2824.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":4236.9,"discounted_cash":4236.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":1412.3,"discounted_cash":1412.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOPAMIDOL 41 % IJ SOLN [10325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"0270-1411-11","type":"NDC"}],"standard_charges":[{"gross_charge":188.7,"discounted_cash":188.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":314.5,"discounted_cash":314.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"IOPAMIDOL 41 % IJ SOLN [10325]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-1411-11","type":"NDC"}],"standard_charges":[{"gross_charge":62.9,"discounted_cash":62.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN [120079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-1802-10","type":"NDC"}],"standard_charges":[{"gross_charge":196.6,"discounted_cash":196.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN [120079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1413-61","type":"NDC"}],"standard_charges":[{"gross_charge":115.6,"discounted_cash":115.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN [120079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1413-59","type":"NDC"}],"standard_charges":[{"gross_charge":106.54,"discounted_cash":106.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"IOHEXOL 300 MG/ML IJ SOLN [120079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1413-10","type":"NDC"}],"standard_charges":[{"gross_charge":262.72,"discounted_cash":262.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN [120080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1412-30","type":"NDC"}],"standard_charges":[{"gross_charge":203.6,"discounted_cash":203.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":305.4,"discounted_cash":305.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":101.8,"discounted_cash":101.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOHEXOL 240 MG/ML IJ SOLN [120080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0407-1412-20","type":"NDC"}],"standard_charges":[{"gross_charge":1485.2,"discounted_cash":1485.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":2227.8,"discounted_cash":2227.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":742.6,"discounted_cash":742.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IOVERSOL 68 % IJ SOLN [137287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0019-1323-16","type":"NDC"}],"standard_charges":[{"gross_charge":123.47,"discounted_cash":123.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":154.34,"discounted_cash":154.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"},{"gross_charge":185.2,"discounted_cash":185.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"},{"gross_charge":246.94,"discounted_cash":246.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":61.74,"discounted_cash":61.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN [29132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"0517-2310-01","type":"NDC"}],"standard_charges":[{"gross_charge":215.18,"discounted_cash":215.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":430.36,"discounted_cash":430.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":645.54,"discounted_cash":645.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"IRON DEXTRAN 50 MG/ML IJ SOLN [3990]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0023-6082-01","type":"NDC"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":48.25,"discounted_cash":48.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":96.5,"discounted_cash":96.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ [129604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9205","type":"HCPCS"},{"code":"15054-0043-1","type":"NDC"}],"standard_charges":[{"gross_charge":7539.4,"discounted_cash":7539.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN [91055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-193-52","type":"NDC"}],"standard_charges":[{"gross_charge":75.2,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN [91055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-349-16","type":"NDC"}],"standard_charges":[{"gross_charge":75.2,"discounted_cash":75.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN [91055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-230-02","type":"NDC"}],"standard_charges":[{"gross_charge":75.34,"discounted_cash":75.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"IRBESARTAN 150 MG PO TABS [21848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-042-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"IRBESARTAN 150 MG PO TABS [21848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-048-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN [29132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"0517-2310-05","type":"NDC"}],"standard_charges":[{"gross_charge":215.27,"discounted_cash":215.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":430.54,"discounted_cash":430.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":645.81,"discounted_cash":645.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN [29132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"0517-2340-10","type":"NDC"}],"standard_charges":[{"gross_charge":225.55,"discounted_cash":225.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":451.1,"discounted_cash":451.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":676.65,"discounted_cash":676.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISONIAZID 300 MG PO TABS [4027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0071-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISONIAZID 100 MG PO TABS [4026]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0066-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ISAVUCONAZONIUM SULFATE 372 MG IV SOLR [128085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0469-0420-99","type":"NDC"}],"standard_charges":[{"gross_charge":1987.6,"discounted_cash":1987.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ISAVUCONAZONIUM SULFATE 186 MG PO CAPS [128084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0469-0520-14","type":"NDC"}],"standard_charges":[{"gross_charge":1206.54,"discounted_cash":1206.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 372 MG"}]},{"description":"ISAVUCONAZONIUM SULFATE 186 MG PO CAPS [128084]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0469-0520-02","type":"NDC"}],"standard_charges":[{"gross_charge":1368.38,"discounted_cash":1368.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 372 MG"}]},{"description":"ISATUXIMAB-IRFC 100 MG/5ML IV SOLN [142366]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"0024-0654-01","type":"NDC"}],"standard_charges":[{"gross_charge":4441.7,"discounted_cash":4441.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IRON SUCROSE 20 MG/ML IV SOLN [29132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"0517-2340-99","type":"NDC"}],"standard_charges":[{"gross_charge":225.55,"discounted_cash":225.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":451.1,"discounted_cash":451.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":676.65,"discounted_cash":676.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"IRBESARTAN 150 MG PO TABS [21848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-048-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-9671-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS [41142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0087-17","type":"NDC"}],"standard_charges":[{"gross_charge":2739.96,"discounted_cash":2739.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.9 G"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN [16070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-398-30","type":"NDC"}],"standard_charges":[{"gross_charge":215.82,"discounted_cash":215.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-7970-93","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-7970-55","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN [12580]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-7970-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"IPILIMUMAB 50 MG/10ML IV SOLN [108955]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"0003-2327-11","type":"NDC"}],"standard_charges":[{"gross_charge":28136.79,"discounted_cash":28136.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IPILIMUMAB 200 MG/40ML IV SOLN [108956]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"0003-2328-22","type":"NDC"}],"standard_charges":[{"gross_charge":64255.92,"discounted_cash":64255.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-9671-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-7146-63","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IRBESARTAN 150 MG PO TABS [21848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0955-1041-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-600-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-600-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-600-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-405-79","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 (3) MG/3ML IN SOLN [93931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-756-49","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"IODINE STRONG 5 % PO SOLN [3961]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0395-2775-16","type":"NDC"}],"standard_charges":[{"gross_charge":349.08,"discounted_cash":349.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"},{"gross_charge":349.08,"discounted_cash":349.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":349.08,"discounted_cash":349.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 DROP"},{"gross_charge":349.08,"discounted_cash":349.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 DROP"},{"gross_charge":349.08,"discounted_cash":349.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 DROP"},{"gross_charge":349.08,"discounted_cash":349.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 DROP"}]},{"description":"IMIPRAMINE HCL 25 MG PO TABS [3861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-055-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE HCL 10 MG PO TABS [3860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-133-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE HCL 25 MG PO TABS [3861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64125-134-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG IV SOLR [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-705-10","type":"NDC"}],"standard_charges":[{"gross_charge":176.18,"discounted_cash":176.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":88.09,"discounted_cash":88.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":132.14,"discounted_cash":132.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IMIPENEM-CILASTATIN 500 MG IV SOLR [9603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-705-01","type":"NDC"}],"standard_charges":[{"gross_charge":177.59,"discounted_cash":177.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":88.8,"discounted_cash":88.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":133.19,"discounted_cash":133.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"IMATINIB MESYLATE 400 MG PO TABS [36092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-623-04","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IMATINIB MESYLATE 400 MG PO TABS [36092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-203-25","type":"NDC"}],"standard_charges":[{"gross_charge":762.61,"discounted_cash":762.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IMIPRAMINE HCL 25 MG PO TABS [3861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-134-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INCLISIRAN SODIUM 284 MG/1.5ML SC SOSY [147270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"0078-1000-60","type":"NDC"}],"standard_charges":[{"gross_charge":12346.05,"discounted_cash":12346.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 284 MG"}]},{"description":"IN LINE FILTER 1.2 MICRON [4080074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"85412-005-08","type":"NDC"}],"standard_charges":[{"gross_charge":21.06,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IMIQUIMOD PUMP 3.75 % EX CREA [137913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4174-9","type":"NDC"}],"standard_charges":[{"gross_charge":5901.26,"discounted_cash":5901.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 G"}]},{"description":"IMIPRAMINE PAMOATE 150 MG PO CAPS [10253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-317-06","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":23.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":47.18,"discounted_cash":47.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":47.18,"discounted_cash":47.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":23.59,"discounted_cash":23.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"IMIPRAMINE HCL 50 MG PO TABS [3862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584-427-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMIPRAMINE HCL 50 MG PO TABS [3862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-135-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"IMATINIB MESYLATE 400 MG PO TABS [36092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0649-30","type":"NDC"}],"standard_charges":[{"gross_charge":2059.19,"discounted_cash":2059.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IMATINIB MESYLATE 100 MG PO TABS [32979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-472-81","type":"NDC"}],"standard_charges":[{"gross_charge":71.96,"discounted_cash":71.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IMATINIB MESYLATE 100 MG PO TABS [32979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0401-34","type":"NDC"}],"standard_charges":[{"gross_charge":569.84,"discounted_cash":569.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ILOPERIDONE 8 MG PO TABS [99457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43068-108-02","type":"NDC"}],"standard_charges":[{"gross_charge":223.4,"discounted_cash":223.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":223.4,"discounted_cash":223.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"IDARUCIZUMAB 2.5 GM/50ML IV SOLN [129586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0597-0197-05","type":"NDC"}],"standard_charges":[{"gross_charge":19063.05,"discounted_cash":19063.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"ICATIBANT ACETATE 30 MG/3ML SC SOSY [150700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-574-86","type":"NDC"}],"standard_charges":[{"gross_charge":1828.46,"discounted_cash":1828.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"IBUTILIDE FUMARATE 1 MG/10ML IV SOLN [100740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-366-10","type":"NDC"}],"standard_charges":[{"gross_charge":1171.0,"discounted_cash":1171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"IBUTILIDE FUMARATE 1 MG/10ML IV SOLN [100740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-3794-01","type":"NDC"}],"standard_charges":[{"gross_charge":580.12,"discounted_cash":580.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"IBUPROFEN 800 MG/8ML IV SOLN [108068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"66220-287-08","type":"NDC"}],"standard_charges":[{"gross_charge":85.63,"discounted_cash":85.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"IBUPROFEN 800 MG PO TABS [3845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-468-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IBUPROFEN 800 MG PO TABS [3845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-468-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"IDELALISIB 100 MG PO TABS [126214]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1701-1","type":"NDC"}],"standard_charges":[{"gross_charge":1093.17,"discounted_cash":1093.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1639.75,"discounted_cash":1639.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"INCOBOTULINUMTOXINA 100 UNITS IM SOLR [105971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0588","type":"HCPCS"},{"code":"0259-1610-01","type":"NDC"}],"standard_charges":[{"gross_charge":3305.62,"discounted_cash":3305.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IDELALISIB 150 MG PO TABS [126215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1702-1","type":"NDC"}],"standard_charges":[{"gross_charge":728.78,"discounted_cash":728.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1093.17,"discounted_cash":1093.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"ILOPERIDONE 6 MG PO TABS [99456]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43068-105-02","type":"NDC"}],"standard_charges":[{"gross_charge":61.12,"discounted_cash":61.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":61.12,"discounted_cash":61.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":61.12,"discounted_cash":61.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":61.12,"discounted_cash":61.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ILOPERIDONE 1 MG PO TABS [99453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43068-101-02","type":"NDC"}],"standard_charges":[{"gross_charge":181.56,"discounted_cash":181.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1815.6,"discounted_cash":1815.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2178.72,"discounted_cash":2178.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":363.12,"discounted_cash":363.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":726.24,"discounted_cash":726.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":1089.36,"discounted_cash":1089.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":1452.48,"discounted_cash":1452.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"IFOSFAMIDE 3 GM/60ML IV SOLN [87926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-3429-11","type":"NDC"}],"standard_charges":[{"gross_charge":667.96,"discounted_cash":667.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"IFOSFAMIDE 3 GM/60ML IV SOLN [87926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9530-01","type":"NDC"}],"standard_charges":[{"gross_charge":527.56,"discounted_cash":527.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"IFOSFAMIDE 1 GM/20ML IV SOLN [87925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9531-01","type":"NDC"}],"standard_charges":[{"gross_charge":191.96,"discounted_cash":191.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"INDAPAMIDE 2.5 MG PO TABS [3879]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-511-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) 100 UNIT/ML SC SUSP [10284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0169-1834-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN NPH (HUMAN) (ISOPHANE) 100 UNIT/ML SC SUSP [10284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0169-1834-02","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN LISPRO PROT & LISPRO (75-25) 100 UNIT/ML SC SUSP [70693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-7511-01","type":"NDC"}],"standard_charges":[{"gross_charge":329.56,"discounted_cash":329.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN LISPRO PROT & LISPRO (50-50) 100 UNIT/ML SC SUPN [125085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-8798-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.37,"discounted_cash":140.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN [147703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-7510-01","type":"NDC"}],"standard_charges":[{"gross_charge":329.56,"discounted_cash":329.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN GLULISINE 100 UNIT/ML IJ SOLN [87889]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0088-2500-33","type":"NDC"}],"standard_charges":[{"gross_charge":523.72,"discounted_cash":523.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INSULIN GLARGINE 100 UNIT/ML SC SOPN [125075]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0088-2219-01","type":"NDC"}],"standard_charges":[{"gross_charge":474.25,"discounted_cash":474.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN GLARGINE (1 UNIT DIAL) 300 UNIT/ML SC SOPN [140797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0024-5869-03","type":"NDC"}],"standard_charges":[{"gross_charge":616.29,"discounted_cash":616.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC SUPN [125083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"73070-203-10","type":"NDC"}],"standard_charges":[{"gross_charge":112.32,"discounted_cash":112.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC SUPN [125083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0169-3696-19","type":"NDC"}],"standard_charges":[{"gross_charge":116.35,"discounted_cash":116.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART FLEXPEN 100 UNIT/ML SC SOPN [141658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"73070-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":112.29,"discounted_cash":112.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART 100 UNIT/ML SC SOPN [125073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"73070-103-15","type":"NDC"}],"standard_charges":[{"gross_charge":116.35,"discounted_cash":116.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN ASPART 100 UNIT/ML IJ SOLN [147704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0169-7501-11","type":"NDC"}],"standard_charges":[{"gross_charge":261.52,"discounted_cash":261.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INOTUZUMAB OZOGAMICIN 0.9 MG IV SOLR [136584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0008-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":42499.1,"discounted_cash":42499.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INFUVITE PEDIATRIC IV SOLN [132401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7886-1","type":"NDC"}],"standard_charges":[{"gross_charge":95.47,"discounted_cash":95.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP [10286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-8715-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INFUVITE PEDIATRIC IV SOLN [132401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-5646-1","type":"NDC"}],"standard_charges":[{"gross_charge":93.97,"discounted_cash":93.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP [10286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-8715-17","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP [10286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0169-1837-11","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IOBENGUANE SULFATE I 123 10 MCI/5ML IV SOLN [98451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"17156-235-01","type":"NDC"}],"standard_charges":[{"gross_charge":12460.86,"discounted_cash":12460.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MILLICURIE"}]},{"description":"INTRASITE GEL [408077]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999108010","type":"NDC"}],"standard_charges":[{"gross_charge":19.52,"discounted_cash":19.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"INTERFERON BETA-1A 30 MCG/0.5ML IM PSKT [129186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q3027","type":"HCPCS"},{"code":"59627-222-05","type":"NDC"}],"standard_charges":[{"gross_charge":5988.29,"discounted_cash":5988.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MCG"}]},{"description":"INSULIN REGULAR(HUMAN) IN NACL 100-0.9 UT/100ML-% IV SOLN [140605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-8215-99","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"INSULIN REGULAR(HUMAN) IN NACL 100-0.9 UT/100ML-% IV SOLN [140605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0126-12","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"INSULIN REGULAR HUMAN 100 UNIT/ML IJ SOLN [10289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-8215-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 UNITS"}]},{"description":"INSULIN REGULAR HUMAN (CONC) 500 UNIT/ML SC SOPN [130929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-8824-01","type":"NDC"}],"standard_charges":[{"gross_charge":3041.05,"discounted_cash":3041.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"INSULIN REGULAR(HUMAN) IN NACL 100-0.9 UT/100ML-% IV SOLN [140605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"9999-8215-99","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"INSULIN REGULAR(HUMAN) IN NACL 100-0.9 UT/100ML-% IV SOLN [140605]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0338-0126-12","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP [10286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"9999-1070-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"INSULIN NPH ISOPHANE & REGULAR (70-30) 100 UNIT/ML SC SUSP [10286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0169-1837-02","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INFUVITE ADULT IV SOLN [155235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-7862-1","type":"NDC"}],"standard_charges":[{"gross_charge":53.8,"discounted_cash":53.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INFUVITE ADULT IV SOLN [155235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-5649-1","type":"NDC"}],"standard_charges":[{"gross_charge":53.8,"discounted_cash":53.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INDOMETHACIN 25 MG PO CAPS [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-430-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 100 MG RE SUPP [149022]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-9999-50","type":"NDC"}],"standard_charges":[{"gross_charge":21.83,"discounted_cash":21.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOCYANINE GREEN 25 MG IV SOLR [10266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"70100-424-02","type":"NDC"}],"standard_charges":[{"gross_charge":899.71,"discounted_cash":899.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INDOCYANINE GREEN 25 MG IJ SOLR [152086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"66259-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":705.32,"discounted_cash":705.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INDIUM WBC STUDY [4089915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999101510","type":"NDC"}],"standard_charges":[{"gross_charge":6335.46,"discounted_cash":6335.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MICROCURIE"}]},{"description":"INDIUM IN 111 PENTETREOTIDE [4089918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999101810","type":"NDC"}],"standard_charges":[{"gross_charge":10268.49,"discounted_cash":10268.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":10268.49,"discounted_cash":10268.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MILLICURIE"}]},{"description":"INDINAVIR SULFATE 400 MG PO CAPS [16645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0573-62","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML IJ SOLN [10265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0375-05","type":"NDC"}],"standard_charges":[{"gross_charge":907.24,"discounted_cash":907.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML IJ SOLN [10265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0375-01","type":"NDC"}],"standard_charges":[{"gross_charge":900.97,"discounted_cash":900.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"INFUVITE ADULT IV SOLN [155235]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54643-5650-2","type":"NDC"}],"standard_charges":[{"gross_charge":275.2,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"INDOMETHACIN 25 MG PO CAPS [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-430-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INDOMETHACIN 25 MG PO CAPS [3897]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-406-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY [127813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"19515-810-52","type":"NDC"}],"standard_charges":[{"gross_charge":116.81,"discounted_cash":116.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":116.81,"discounted_cash":116.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INFLUENZA VIRUS VACC SPLIT PF 0.5 ML IM SUSY [127813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"19515-810-41","type":"NDC"}],"standard_charges":[{"gross_charge":116.81,"discounted_cash":116.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":116.81,"discounted_cash":116.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY [127814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49281-124-88","type":"NDC"}],"standard_charges":[{"gross_charge":411.17,"discounted_cash":411.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"INFLUENZA VAC SPLIT HIGH-DOSE 0.5 ML IM SUSY [127814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49281-124-65","type":"NDC"}],"standard_charges":[{"gross_charge":411.17,"discounted_cash":411.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"INFLIXIMAB-DYYB 100 MG IV SOLR [132496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5103","type":"HCPCS"},{"code":"0069-0809-01","type":"NDC"}],"standard_charges":[{"gross_charge":2644.1,"discounted_cash":2644.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INFLIXIMAB-AXXQ 100 MG IV SOLR [143004]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5121","type":"HCPCS"},{"code":"55513-670-01","type":"NDC"}],"standard_charges":[{"gross_charge":3095.43,"discounted_cash":3095.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INFLIXIMAB 100 MG IV SOLR [23796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1745","type":"HCPCS"},{"code":"57894-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":4295.1,"discounted_cash":4295.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"INDOMETHACIN ER 75 MG PO CPCR [14628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-325-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"INDOMETHACIN ER 75 MG PO CPCR [14628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-411-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"INDOMETHACIN 50 MG RE SUPP [3901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69344-102-33","type":"NDC"}],"standard_charges":[{"gross_charge":2562.23,"discounted_cash":2562.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":640.56,"discounted_cash":640.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1281.12,"discounted_cash":1281.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-895-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"GALCANEZUMAB-GNLM 120 MG/ML SC SOAJ [138268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-1436-01","type":"NDC"}],"standard_charges":[{"gross_charge":3926.82,"discounted_cash":3926.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":7853.64,"discounted_cash":7853.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"GALANTAMINE HYDROBROMIDE ER 8 MG PO CP24 [41138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-744-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE HYDROBROMIDE ER 8 MG PO CP24 [41138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-835-83","type":"NDC"}],"standard_charges":[{"gross_charge":54.2,"discounted_cash":54.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":81.29,"discounted_cash":81.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":27.1,"discounted_cash":27.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALCANEZUMAB-GNLM 120 MG/ML SC SOAJ [138268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-1436-11","type":"NDC"}],"standard_charges":[{"gross_charge":3926.82,"discounted_cash":3926.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":7853.64,"discounted_cash":7853.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"GALANTAMINE HYDROBROMIDE ER 8 MG PO CP24 [41138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3496-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALANTAMINE HYDROBROMIDE 4 MG PO TABS [29806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-458-60","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GALLIUM GA 67 CITRATE [4089908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"A9556","type":"HCPCS"},{"code":"99999100810","type":"NDC"}],"standard_charges":[{"gross_charge":3215.33,"discounted_cash":3215.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"GANCICLOVIR 0.15 % OP GEL [104575]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24208-535-35","type":"NDC"}],"standard_charges":[{"gross_charge":2650.29,"discounted_cash":2650.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"GENTAMICIN FORTIFIED OPHTHALMIC DROPS CMPD 14 MG/ML [4081166]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-6003-62","type":"NDC"}],"standard_charges":[{"gross_charge":69.82,"discounted_cash":69.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR [136649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9203","type":"HCPCS"},{"code":"0008-4510-01","type":"NDC"}],"standard_charges":[{"gross_charge":36558.92,"discounted_cash":36558.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GEMFIBROZIL 600 MG PO TABS [3378]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-131-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN [112866]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-0183-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.71,"discounted_cash":71.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.26 ML"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN [112868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"9999-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.15,"discounted_cash":71.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 52.6 ML"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN [112867]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":147.36,"discounted_cash":147.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26.3 ML"}]},{"description":"GEL-FLOW NT EX PRSY [134916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-1040-06","type":"NDC"}],"standard_charges":[{"gross_charge":409.89,"discounted_cash":409.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"GELCLAIR MT GEL [32810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"89141-456-02","type":"NDC"}],"standard_charges":[{"gross_charge":248.94,"discounted_cash":248.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"GELATIN ADSORBABLE OP FILM [28028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0297-03","type":"NDC"}],"standard_charges":[{"gross_charge":788.47,"discounted_cash":788.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GELATIN ABSORBABLE MT POWD [28017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"12123-00024","type":"NDC"}],"standard_charges":[{"gross_charge":467.11,"discounted_cash":467.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"GELATIN ABSORBABLE 12-7 MM EX MISC [28018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0315-08","type":"NDC"}],"standard_charges":[{"gross_charge":24.93,"discounted_cash":24.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GELATIN ABSORBABLE 100 EX MISC [28025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0342-01","type":"NDC"}],"standard_charges":[{"gross_charge":115.16,"discounted_cash":115.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GANCICLOVIR SODIUM 500 MG IV SOLR [10101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-315-94","type":"NDC"}],"standard_charges":[{"gross_charge":270.24,"discounted_cash":270.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GANCICLOVIR SODIUM 500 MG IV SOLR [10101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9299-01","type":"NDC"}],"standard_charges":[{"gross_charge":330.63,"discounted_cash":330.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN [41137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9578","type":"HCPCS"},{"code":"9999-1800-10","type":"NDC"}],"standard_charges":[{"gross_charge":236.85,"discounted_cash":236.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN [41137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9578","type":"HCPCS"},{"code":"0270-5164-15","type":"NDC"}],"standard_charges":[{"gross_charge":191.82,"discounted_cash":191.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN [41137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9578","type":"HCPCS"},{"code":"0270-5164-14","type":"NDC"}],"standard_charges":[{"gross_charge":198.07,"discounted_cash":198.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN [41137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9578","type":"HCPCS"},{"code":"0270-5164-13","type":"NDC"}],"standard_charges":[{"gross_charge":285.2,"discounted_cash":285.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GABAPENTIN 400 MG PO CAPS [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-103-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 400 MG PO CAPS [18307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG PO CAPS [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-199-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG PO CAPS [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-199-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 300 MG PO CAPS [18308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-102-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN [15906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0503-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GABAPENTIN 600 MG PO TABS [25855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-411-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"GABAPENTIN ENACARBIL ER 600 MG PO TBCR [125856]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53451-0101-1","type":"NDC"}],"standard_charges":[{"gross_charge":107.47,"discounted_cash":107.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":107.47,"discounted_cash":107.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GABAPENTIN 800 MG PO TABS [25856]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"GABAPENTIN 800 MG PO TABS [25856]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-524-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"GENTAMICIN IN SALINE 1-0.9 MG/ML-% IV SOLN [15908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0505-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG PO TB24 [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-295-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG PO TB24 [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-279-03","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG PO TB24 [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-480-21","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 2.5 MG PO TB24 [37648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-480-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 10 MG PO TB24 [37650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-746-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG PO TB24 [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0844-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE 5 MG PO TABS [10117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0141-0","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIPIZIDE ER 5 MG PO TB24 [37649]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0844-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYBURIDE 2.5 MG PO TABS [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-057-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLUCOSE 40 % PO GEL [81823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0069-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G OF GLUCOSE"}]},{"description":"GLUCOSE 40 % PO GEL [81823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00574-06945","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G OF GLUCOSE"}]},{"description":"GLUCOSE 40 % PO GEL [81823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00574-06930","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G OF GLUCOSE"}]},{"description":"GLUCOSE 40 % PO GEL [81823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"00574-06915","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G OF GLUCOSE"}]},{"description":"GLUCOSE 15 GM/32ML PO GEL [135921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56151-1625-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G OF GLUCOSE"}]},{"description":"GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR [41581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0597-0053-45","type":"NDC"}],"standard_charges":[{"gross_charge":514.94,"discounted_cash":514.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR [128527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-596-13","type":"NDC"}],"standard_charges":[{"gross_charge":903.06,"discounted_cash":903.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR [128527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-596-11","type":"NDC"}],"standard_charges":[{"gross_charge":252.6,"discounted_cash":252.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR [128527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-596-03","type":"NDC"}],"standard_charges":[{"gross_charge":707.77,"discounted_cash":707.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GLUCAGON HCL (DIAGNOSTIC) 1 MG IJ SOLR [128527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-593-03","type":"NDC"}],"standard_charges":[{"gross_charge":903.07,"discounted_cash":903.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT [38304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0548-5905-00","type":"NDC"}],"standard_charges":[{"gross_charge":1097.44,"discounted_cash":1097.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GLUCAGON EMERGENCY 1 MG IJ KIT [38304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0548-5850-00","type":"NDC"}],"standard_charges":[{"gross_charge":1085.63,"discounted_cash":1085.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"GLIPIZIDE 10 MG PO TABS [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0142-0","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-010-95","type":"NDC"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-010-41","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1207-15","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN [3426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1207-13","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN [3425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-173-94","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN [3425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-173-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN [3425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN [3428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-633-05","type":"NDC"}],"standard_charges":[{"gross_charge":22.53,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN [3428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60758-188-05","type":"NDC"}],"standard_charges":[{"gross_charge":26.07,"discounted_cash":26.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX CREA [3423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-056-35","type":"NDC"}],"standard_charges":[{"gross_charge":40.23,"discounted_cash":40.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"GENTLE CLEANSER (BABY PHISODERM) SOAP [4080076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999-1079-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 236 ML"}]},{"description":"GLATIRAMER ACETATE 20 MG/ML SC SOSY [127796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6960-93","type":"NDC"}],"standard_charges":[{"gross_charge":339.15,"discounted_cash":339.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"GLIPIZIDE 10 MG PO TABS [10116]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0461-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLIMEPIRIDE 4 MG PO TABS [16357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-125-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 1 MG PO TABS [16355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-320-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLIMEPIRIDE 1 MG PO TABS [16355]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"GLECAPREVIR-PIBRENTASVIR 100-40 MG PO TABS [136493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-2625-28","type":"NDC"}],"standard_charges":[{"gross_charge":2943.33,"discounted_cash":2943.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"GI COCKTAIL W/ LIDOCAINE KIT [40840840039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-5280-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42192-608-45","type":"NDC"}],"standard_charges":[{"gross_charge":20.91,"discounted_cash":20.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.91,"discounted_cash":20.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":62.73,"discounted_cash":62.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":83.64,"discounted_cash":83.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-36","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-26","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML PO SOLN [3292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3294-46","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"64679-759-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-45","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-43","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-6102-19","type":"NDC"}],"standard_charges":[{"gross_charge":49.35,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.7,"discounted_cash":98.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":148.05,"discounted_cash":148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":197.4,"discounted_cash":197.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-6102-18","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-6102-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-6102-02","type":"NDC"}],"standard_charges":[{"gross_charge":43.14,"discounted_cash":43.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":86.27,"discounted_cash":86.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":129.4,"discounted_cash":129.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":172.53,"discounted_cash":172.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY [149049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70121-1463-2","type":"NDC"}],"standard_charges":[{"gross_charge":238.48,"discounted_cash":238.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":476.96,"discounted_cash":476.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-473-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"36000-283-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN [3291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-473-32","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG PO TABS [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4297-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-137-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-179-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-605-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-661-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-101-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN [29169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-0600-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"GABAPENTIN 100 MG PO CAPS [18309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-101-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FUROSEMIDE 80 MG PO TABS [3296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG PO TABS [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-117-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 40 MG PO TABS [3295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8299-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 20 MG PO TABS [3294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8297-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 8 MG/ML PO SOLN [3293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-3298-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 80 MG PO TABS [3296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-626-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 80 MG PO TABS [3296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0232-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FUROSEMIDE 80 MG PO TABS [3296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0232-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ISONIAZID 300 MG PO TABS [4027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0071-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"GLYBURIDE 2.5 MG PO TABS [10126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72241-039-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0901-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.74,"discounted_cash":57.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":86.61,"discounted_cash":86.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":115.48,"discounted_cash":115.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDRALAZINE HCL 100 MG PO TABS [3699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-522-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE HCL 10 MG PO TABS [3698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-398-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYALURONIDASE HUMAN 200 UNITS IN LIDOCAINE 2% 10 ML [4084044495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3471","type":"HCPCS"},{"code":"99999-6003-86","type":"NDC"}],"standard_charges":[{"gross_charge":469.84,"discounted_cash":469.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HYALURONIDASE HUMAN 150-0.9 UNITS/10ML-% IV SOLN STOCK DILUTION [40840449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3471","type":"HCPCS"},{"code":"9999-6003-34","type":"NDC"}],"standard_charges":[{"gross_charge":331.88,"discounted_cash":331.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HYALURONIDASE HUMAN 150 UNIT/ML IJ SOLN [76338]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657-117-04","type":"NDC"}],"standard_charges":[{"gross_charge":331.91,"discounted_cash":331.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYALURONIDASE HUMAN 150 UNIT/ML IJ SOLN [76338]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3473","type":"HCPCS"},{"code":"18657-117-01","type":"NDC"}],"standard_charges":[{"gross_charge":335.14,"discounted_cash":335.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"17478-934-15","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":59.84,"discounted_cash":59.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":79.78,"discounted_cash":79.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-614-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":43.04,"discounted_cash":43.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-614-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":43.04,"discounted_cash":43.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 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[34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0123-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS [34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-396-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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[34505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6824-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"HYDROCODONE BIT-HOMATROP MBR 5-1.5 MG/5ML PO SOLN [147697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-043-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE BIT-HOMATROP MBR 5-1.5 MG/5ML PO SOLN [147697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-1030-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS [19146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 12.5 MG PO CAPS [19146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-130-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"HYDRALAZINE HCL 50 MG PO TABS [3701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-735-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE HCL 25 MG PO TABS [3700]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-291-00","type":"NDC"}],"standard_charges":[{"gross_charge":48.81,"discounted_cash":48.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":73.21,"discounted_cash":73.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":97.62,"discounted_cash":97.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-2083-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-2083-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCODONE BIT-HOMATROP MBR 5-1.5 MG/5ML PO SOLN [147697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4811-40","type":"NDC"}],"standard_charges":[{"gross_charge":19.58,"discounted_cash":19.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":39.15,"discounted_cash":39.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE BIT-HOMATROP MBR 5-1.5 MG/5ML PO SOLN [147697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4811-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE BIT-HOMATROP MBR 5-1.5 MG/5ML PO SOLN [147697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1036-05","type":"NDC"}],"standard_charges":[{"gross_charge":23.28,"discounted_cash":23.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":46.56,"discounted_cash":46.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCODONE BITARTRATE ER 30 MG PO TABLET EXTEN [127206]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-393-60","type":"NDC"}],"standard_charges":[{"gross_charge":68.15,"discounted_cash":68.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"HYDROCOD POLI-CHLORPHE POLI ER 10-8 MG/5ML PO SUER [150219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1077-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCOD POLI-CHLORPHE POLI ER 10-8 MG/5ML PO SUER [150219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-086-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.69,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584-361-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HYDROCHLOROTHIAZIDE 25 MG PO TABS [3720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-956-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"GOSERELIN ACETATE 10.8 MG SC IMPL [16254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0310-0951-30","type":"NDC"}],"standard_charges":[{"gross_charge":7714.14,"discounted_cash":7714.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.8 MG"},{"gross_charge":2600.72,"discounted_cash":2600.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.6 MG"}]},{"description":"GOLIMUMAB 50 MG/4ML IV SOLN [123001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1602","type":"HCPCS"},{"code":"57894-350-01","type":"NDC"}],"standard_charges":[{"gross_charge":7302.44,"discounted_cash":7302.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"GOLIMUMAB 50 MG/0.5ML SC SOAJ [125868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"57894-070-02","type":"NDC"}],"standard_charges":[{"gross_charge":32230.71,"discounted_cash":32230.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":64461.42,"discounted_cash":64461.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":16115.36,"discounted_cash":16115.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"GLYCOPYRROLATE-FORMOTEROL 9-4.8 MCG/ACT IN AERO [131544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-4600-12","type":"NDC"}],"standard_charges":[{"gross_charge":2103.58,"discounted_cash":2103.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.7 G"}]},{"description":"GLYCOPYRROLATE PF 0.2 MG/ML IJ SOLN [137737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-6000-4","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"GLYCOPYRROLATE PF 0.2 MG/ML IJ SOLN [137737]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-6000-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"GLYCOPYRROLATE 1 MG PO TABS [10130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-014-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GOSERELIN ACETATE 3.6 MG SC IMPL [10137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70720-950-36","type":"NDC"}],"standard_charges":[{"gross_charge":7282.88,"discounted_cash":7282.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.8 MG"},{"gross_charge":2456.96,"discounted_cash":2456.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.6 MG"}]},{"description":"GRANISETRON HCL 1 MG/ML IV SOLN [12552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1626","type":"HCPCS"},{"code":"63323-318-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN [79088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1775-40","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GUAIFENESIN ER 600 MG PO TB12 [37651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-008-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQD [13748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-9991-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQD [13748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70677-1186-2","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQD [13748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1314-85","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQD [13748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1744-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQD [13748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1744-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GRANISETRON IN NACL 1-0.9 MG/50ML-% IV SOLN [400159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1626","type":"HCPCS"},{"code":"99999-319-05","type":"NDC"}],"standard_charges":[{"gross_charge":1136.52,"discounted_cash":1136.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GRANISETRON HCL 4 MG/4ML IV SOLN [92107]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1626","type":"HCPCS"},{"code":"67457-864-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GRANISETRON HCL 1 MG/ML IV SOLN [12552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1626","type":"HCPCS"},{"code":"67457-863-01","type":"NDC"}],"standard_charges":[{"gross_charge":43.62,"discounted_cash":43.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INH SOLN [408223497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-4601-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN [3497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-578-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":44.47,"discounted_cash":44.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":66.71,"discounted_cash":66.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"GLYCERIN (INFANTS & CHILDREN) 1 G RE SUPP [117884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58980-409-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 SUPPOSITORY"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 SUPPOSITORY"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"}]},{"description":"GLYCERIN (INFANTS & CHILDREN) 1 G RE SUPP [117884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58980-409-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 SUPPOSITORY"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 SUPPOSITORY"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"}]},{"description":"GLYBURIDE MICRONIZED 3 MG PO TABS [14778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8035-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"GLYBURIDE 5 MG PO TABS [3489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"GLYCERIN (INFANTS & CHILDREN) 1 G RE SUPP [117884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70000-0429-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 SUPPOSITORY"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 SUPPOSITORY"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN [3497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-578-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN [3497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43547-543-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN [3497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43547-543-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"GLYCINE 1.5 % IR SOLN [3493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7974-08","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 ML"}]},{"description":"GLYCERIN (LIQUID) 2.8 G RE SUPP [151182]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0132-0190-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"GLYCERIN (LIQUID) 2.8 G RE SUPP [151182]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0132-0190-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"GLYCERIN (LAXATIVE) 2 G RE SUPP [41003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0132-0079-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 EACH"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN [79088]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-087-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GUANFACINE HCL 1 MG PO TABS [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-458-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN - LOW DOSE [148623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-7793-52","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN - DVT/PE [148624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"99999-523-74","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN - DVT/PE [148624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323-523-74","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN [150713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253-333-35","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN [150713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253-333-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN [150713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253-333-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN [150713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253-333-23","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN [150713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253-333-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"}]},{"description":"HEPARIN (PORCINE) IN NACL 4000-0.9 UNIT/L-% IV SOLN [131853]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-122-99","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 2000-0.9 UNIT/L-% IV SOLN [139457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-519-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 2000-0.9 UNIT/L-% IV SOLN [139457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2222-12","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 2000-0.9 UNIT/L-% IV SOLN [139457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2222-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-385-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-540-15","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN [10176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-540-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"}]},{"description":"HEPARIN SOD (PORK) LOCK FLUSH 100 UNIT/ML IV SOLN [105387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"68883-100-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 UNITS"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN [24329]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"0409-4520-02","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 2000-0.9 UNIT/L-% IV SOLN [139457]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-9872-00","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN [3584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-474-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL 1 MG PO TABS [3579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0257-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR [11931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-545-03","type":"NDC"}],"standard_charges":[{"gross_charge":91.32,"discounted_cash":91.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP [125834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4897-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.32,"discounted_cash":158.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GUANFACINE HCL ER 1 MG PO TB24 [99835]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-924-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"GUANFACINE HCL 1 MG PO TABS [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-711-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"GUANFACINE HCL 1 MG PO TABS [10149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-711-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"HALOPERIDOL 5 MG PO TABS [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-736-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HEMOCYTE PLUS 106-1 MG PO CAPS [33622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52747-800-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML PO CONC [3585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0581-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML IM SOLN [10163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-030-03","type":"NDC"}],"standard_charges":[{"gross_charge":262.9,"discounted_cash":262.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":65.73,"discounted_cash":65.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":131.45,"discounted_cash":131.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HALOPERIDOL DECANOATE 50 MG/ML IM SOLN [10163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":203.05,"discounted_cash":203.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":50.77,"discounted_cash":50.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":101.53,"discounted_cash":101.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"HALOPERIDOL 5 MG PO TABS [3583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOPROPYL ALCOHOL 70 % N/A SOLN [4030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0067-16","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"LISDEXAMFETAMINE DIMESYLATE 20 MG PO CAPS [89783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-047-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":42.88,"discounted_cash":42.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"LIRAGLUTIDE 18 MG/3ML SC SOPN [125087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-4060-13","type":"NDC"}],"standard_charges":[{"gross_charge":1623.81,"discounted_cash":1623.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIRAGLUTIDE 18 MG/3ML SC SOPN [125087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0169-4060-12","type":"NDC"}],"standard_charges":[{"gross_charge":1692.35,"discounted_cash":1692.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIOTHYRONINE SODIUM 5 MCG PO TABS [10443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-018-12","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":183.75,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE SODIUM 25 MCG PO TABS [4504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-019-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIOTHYRONINE SODIUM 10 MCG/ML IV SOLN [10442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":2483.29,"discounted_cash":2483.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MCG"},{"gross_charge":620.83,"discounted_cash":620.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MCG"},{"gross_charge":4966.57,"discounted_cash":4966.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"},{"gross_charge":1241.65,"discounted_cash":1241.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"}]},{"description":"LISINOPRIL 10 MG PO TABS [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-334-08","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 10 MG PO TABS [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-334-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISDEXAMFETAMINE DIMESYLATE 30 MG PO CAPS [81474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-048-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":28.59,"discounted_cash":28.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"LIOTHYRONINE SODIUM 10 MCG/ML IV SOLN [10442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-0151-1","type":"NDC"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":2331.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MCG"},{"gross_charge":582.75,"discounted_cash":582.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MCG"},{"gross_charge":4662.0,"discounted_cash":4662.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MCG"},{"gross_charge":1165.5,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"}]},{"description":"LIDOCAINE-SODIUM BICARBONATE 1-8.4 % IJ SOSY [131935]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1175-46","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX KIT [11934]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0357-56","type":"NDC"}],"standard_charges":[{"gross_charge":47.68,"discounted_cash":47.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-582-04","type":"NDC"}],"standard_charges":[{"gross_charge":35.46,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-667-30","type":"NDC"}],"standard_charges":[{"gross_charge":75.24,"discounted_cash":75.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA [10434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0357-30","type":"NDC"}],"standard_charges":[{"gross_charge":90.18,"discounted_cash":90.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN DENTAL [4082010430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66312-176-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-483-27","type":"NDC"}],"standard_charges":[{"gross_charge":52.96,"discounted_cash":52.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3182-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3182-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3182-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-57","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-27","type":"NDC"}],"standard_charges":[{"gross_charge":52.6,"discounted_cash":52.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-482-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3178-17","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-SODIUM BICARBONATE 1-8.4 % IJ SOSY [131935]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-1028-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-SODIUM BICARBONATE IJ SOSY [4081132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"15082-0023-61","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LIDO-EPINEPHRINE-TETRACAINE 1-0.25-0.5 % EX GEL [4081131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-1027-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.39,"discounted_cash":28.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE"},{"gross_charge":28.39,"discounted_cash":28.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN [130416]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"66794-219-43","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN [130416]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-713-03","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN [130416]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"57664-683-57","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN [130416]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"57664-683-31","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINEZOLID 600 MG PO TABS [28224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-749-20","type":"NDC"}],"standard_charges":[{"gross_charge":35.44,"discounted_cash":35.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LINAGLIPTIN 5 MG PO TABS [109773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0140-61","type":"NDC"}],"standard_charges":[{"gross_charge":103.49,"discounted_cash":103.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LINAGLIPTIN 5 MG PO TABS [109773]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0140-30","type":"NDC"}],"standard_charges":[{"gross_charge":88.13,"discounted_cash":88.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LINACLOTIDE 72 MCG PO CAPS [133559]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1203-30","type":"NDC"}],"standard_charges":[{"gross_charge":335.67,"discounted_cash":335.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MCG"},{"gross_charge":559.44,"discounted_cash":559.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290 MCG"},{"gross_charge":111.89,"discounted_cash":111.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 72 MCG"}]},{"description":"LINACLOTIDE 290 MCG PO CAPS [117990]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1202-30","type":"NDC"}],"standard_charges":[{"gross_charge":111.89,"discounted_cash":111.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290 MCG"}]},{"description":"LINACLOTIDE 145 MCG PO CAPS [117989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1201-30","type":"NDC"}],"standard_charges":[{"gross_charge":111.89,"discounted_cash":111.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MCG"},{"gross_charge":223.78,"discounted_cash":223.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 290 MCG"}]},{"description":"LISINOPRIL 10 MG PO TABS [10449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-980-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LITHIUM CARBONATE ER 300 MG PO TBCR [10454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-205-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"LITHIUM CARBONATE ER 300 MG PO TBCR [10454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0021-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"LITHIUM CARBONATE 300 MG PO TABS [4531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-430-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE 300 MG PO TABS [4531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8528-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LITHIUM CARBONATE 300 MG PO CAPS [4529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-545-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"LISINOPRIL 5 MG PO TABS [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-352-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LITHIUM CARBONATE ER 300 MG PO TBCR [10454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-223-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN [143080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-544-26","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN [143080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6836-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN [143080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0134-08","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN [143080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0134-04","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"LMX 4 PLUS 4 % EX KIT [36766]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0496-0882-71","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LITHIUM CARBONATE ER 450 MG PO TBCR [10455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"LITHIUM CARBONATE ER 450 MG PO TBCR [10455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0020-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3178-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LISINOPRIL 20 MG PO TABS [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-335-08","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG PO TABS [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-333-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG PO TABS [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-354-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 5 MG PO TABS [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-352-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 5 MG PO TABS [10451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6797-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LISINOPRIL 20 MG PO TABS [4526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-981-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LOPERAMIDE HCL 2 MG PO CAPS [4560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-229-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3178-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN [10426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-481-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE 5 % EX PTCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"82347-0505-4","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % EX PTCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65162-791-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % EX PTCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"82347-0505-5","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % EX PTCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42858-118-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % EX PTCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0603-1880-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE 5 % EX PTCH [28203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-9055-16","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":19.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":38.52,"discounted_cash":38.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"},{"gross_charge":57.78,"discounted_cash":57.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PATCH"}]},{"description":"LIDOCAINE HCL (PF) 0.5 % IJ SOLN [106363]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-491-57","type":"NDC"}],"standard_charges":[{"gross_charge":106.3,"discounted_cash":106.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-36","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-27","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-26","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-09","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150-162-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150-161-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150-159-74","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0409-4713-65","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0409-4713-32","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0409-4713-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0409-4713-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0409-4713-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0143-9595-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE 5 % EX OINT [41831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64380-789-32","type":"NDC"}],"standard_charges":[{"gross_charge":51.04,"discounted_cash":51.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 G"}]},{"description":"LIDOCAINE 4 % EX CREA [23461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24357-701-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG PO TABS [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1833-7","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":13.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":17.41,"discounted_cash":17.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":20.89,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":27.85,"discounted_cash":27.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG PO TABS [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-6594-90","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":13.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":17.41,"discounted_cash":17.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":20.89,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":27.85,"discounted_cash":27.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 75 MCG PO TABS [4422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1832-1","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":32.67,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1831-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-41","type":"NDC"}],"standard_charges":[{"gross_charge":44.68,"discounted_cash":44.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LEVOTHYROXINE SODIUM 88 MCG PO TABS [10403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1833-1","type":"NDC"}],"standard_charges":[{"gross_charge":13.93,"discounted_cash":13.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":17.41,"discounted_cash":17.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":20.89,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":27.85,"discounted_cash":27.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 MCG"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-43","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-57","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN [104207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323-492-97","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN FOR POST-OP PAIN MANAGEMENT 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[14868]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2002","type":"HCPCS"},{"code":"0264-9594-20","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY [140996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3015-5","type":"NDC"}],"standard_charges":[{"gross_charge":53.16,"discounted_cash":53.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY 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[4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0409-4276-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN [4452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"0143-9577-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LOPINAVIR-RITONAVIR 200-50 MG PO TABS [43391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-6799-22","type":"NDC"}],"standard_charges":[{"gross_charge":53.29,"discounted_cash":53.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":106.58,"discounted_cash":106.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1754-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.52,"discounted_cash":50.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":101.04,"discounted_cash":101.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN [129181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN [129181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-6729-09","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN [129181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-3164-12","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 40 GM/1000ML IV SOLN [129181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"0409-3164-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1754-15","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":50.44,"discounted_cash":50.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-106-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-1715-40","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-6729-11","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-1708-40","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN [129178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-4204-52","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE (LAXATIVE) PO GRAN [27322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-0602-43","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"MAGNESIUM OXIDE 400 MG PO TABS [118176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-339-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN [129179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4121-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-064-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MANNITOL 20 % IV SOLN [4084084749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0357-02","type":"NDC"}],"standard_charges":[{"gross_charge":200.5,"discounted_cash":200.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":185.5,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":200.5,"discounted_cash":200.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":185.5,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":200.5,"discounted_cash":200.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":185.5,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":200.5,"discounted_cash":200.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"},{"gross_charge":185.5,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"}]},{"description":"MANNITOL 0 MG IN CAPS [4085111568]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7665","type":"HCPCS"},{"code":"67850-552-01","type":"NDC"}],"standard_charges":[{"gross_charge":738.5,"discounted_cash":738.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"MALATHION 0.5 % EX LOTN [10502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-5294-4","type":"NDC"}],"standard_charges":[{"gross_charge":1027.67,"discounted_cash":1027.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN [135080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-108-26","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN [135080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-108-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-642-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-642-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-064-43","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN [4720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-064-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MAGNESIUM OXIDE 400 MG PO TAB WR [40889740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-02302","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG PO TAB WR [40889740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-339-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-649-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0788-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0431-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN [4711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-7889-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN [4711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-0051-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN [4711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-389-98","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN [4711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7418-44","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN [4711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-0166-38","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"MAGNESIUM CHLORIDE 64 MG PO TBEC [134808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10006-70013","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 128 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64 MG"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-429-45","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAGNESIUM OXIDE 400 MG PO TAB WR [40889740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60258-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG PO TAB WR [40889740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-634-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG PO TAB WR [40889740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"40985-27072","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM OXIDE 400 MG PO TAB WR [40889740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10006-70028","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-053-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP [28836]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-429-76","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MANNITOL 20 % IV SOLN [4084084749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7715-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":77.0,"discounted_cash":77.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":139.0,"discounted_cash":139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":154.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6517-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69618-027-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-490-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-490-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-775-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-775-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-661-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEDIUM CHAIN TRIGLYCERIDES PO OIL [10518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41679-36503","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-730-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-730-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 25 MG PO TABS [12025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-121-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-522-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MANNITOL 25 % IV SOLN [4750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4031-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"}]},{"description":"MANNITOL 20 % IV SOLN [4749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7715-12","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"}]},{"description":"MANNITOL 25 % IV SOLN [4750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4031-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-522-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MECLIZINE HCL 12.5 MG PO TABS [12024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0440-7735-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEASLES, MUMPS & RUBELLA VAC IJ SOLR [140776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0006-4681-01","type":"NDC"}],"standard_charges":[{"gross_charge":373.3,"discounted_cash":373.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MEASLES, MUMPS & RUBELLA VAC IJ SOLR [140776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0006-4681-00","type":"NDC"}],"standard_charges":[{"gross_charge":561.57,"discounted_cash":561.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MANNITOL 25 % IV SOLN [4750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-024-25","type":"NDC"}],"standard_charges":[{"gross_charge":60.7,"discounted_cash":60.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":121.4,"discounted_cash":121.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":242.8,"discounted_cash":242.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"},{"gross_charge":60.7,"discounted_cash":60.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 G"}]},{"description":"MAGNESIUM 4 GM/100 ML INFUSION [408129179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"53323-0106-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGIC MOUTHWASH W/ LIDOCAINE [4081128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-2101-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.5,"discounted_cash":30.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6207-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6046-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6207-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6046-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-905-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 4 MG/ML IJ SOLN [10468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6047-01","type":"NDC"}],"standard_charges":[{"gross_charge":102.88,"discounted_cash":102.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LORAZEPAM 4 MG/ML IJ SOLN [10468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6002-10","type":"NDC"}],"standard_charges":[{"gross_charge":130.81,"discounted_cash":130.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LORAZEPAM 4 MG/ML IJ SOLN [10468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"0641-6002-01","type":"NDC"}],"standard_charges":[{"gross_charge":130.74,"discounted_cash":130.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LORAZEPAM 2 MG/ML PO CONC [4571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0121-0770-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76329-8261-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN [10467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76329-8261-0","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-773-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG PO TABS [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-401-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 0.5 MG PO TABS [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0240-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORATADINE-PSEUDOEPHEDRINE ER 10-240 MG PO TB24 [27521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5833-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LORATADINE 5 MG/5ML PO SOLN [107845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-449-98","type":"NDC"}],"standard_charges":[{"gross_charge":6.36,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"LORATADINE 10 MG PO TABS [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-788-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG PO TABS [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-650-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LORATADINE 10 MG PO TABS [10466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-471-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN [28929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-3956-46","type":"NDC"}],"standard_charges":[{"gross_charge":2177.73,"discounted_cash":2177.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":2177.73,"discounted_cash":2177.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LORAZEPAM-DIPHENHYDRAMINE-HALOPERIDOL (ABH) 1-50-1 MG GEL [4080075]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1078-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.88,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":32.88,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LORAZEPAM 0.5 MG PO TABS [4572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-627-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-638-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-084-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6008-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3426-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LORAZEPAM 1 MG PO TABS [4573]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3426-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"LOSARTAN POTASSIUM 100 MG PO TABS [22588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-029-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LURASIDONE HCL 40 MG PO TABS [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-347-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE HCL 20 MG PO TABS [113546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-207-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE HCL 20 MG PO TABS [113546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-302-30","type":"NDC"}],"standard_charges":[{"gross_charge":271.23,"discounted_cash":271.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":542.46,"discounted_cash":542.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":1084.92,"discounted_cash":1084.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LUBIPROSTONE 8 MCG PO CAPS [91534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64764-080-60","type":"NDC"}],"standard_charges":[{"gross_charge":110.94,"discounted_cash":110.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":36.98,"discounted_cash":36.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 8 MCG PO CAPS [91534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0254-3028-02","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 24 MCG PO CAPS [70472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70710-1642-6","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 24 MCG PO CAPS [70472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64764-240-60","type":"NDC"}],"standard_charges":[{"gross_charge":36.98,"discounted_cash":36.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":36.98,"discounted_cash":36.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LUBIPROSTONE 24 MCG PO CAPS [70472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0254-3029-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MCG"}]},{"description":"LURASIDONE HCL 40 MG PO TABS [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-495-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"MAGIC BUTT BALM [4081149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-452-31","type":"NDC"}],"standard_charges":[{"gross_charge":65.55,"discounted_cash":65.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 OZ"}]},{"description":"MAFENIDE ACETATE 85 MG/GM EX CREA [10478]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-723-60","type":"NDC"}],"standard_charges":[{"gross_charge":388.85,"discounted_cash":388.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56.7 G"}]},{"description":"LURASIDONE HCL 80 MG PO TABS [107669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-308-30","type":"NDC"}],"standard_charges":[{"gross_charge":274.1,"discounted_cash":274.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE HCL 80 MG PO TABS [107669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-308-10","type":"NDC"}],"standard_charges":[{"gross_charge":250.69,"discounted_cash":250.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE HCL 80 MG PO TABS [107669]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-685-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE HCL 40 MG PO TABS [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-304-30","type":"NDC"}],"standard_charges":[{"gross_charge":271.23,"discounted_cash":271.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":271.23,"discounted_cash":271.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":542.46,"discounted_cash":542.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE HCL 40 MG PO TABS [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-304-10","type":"NDC"}],"standard_charges":[{"gross_charge":119.49,"discounted_cash":119.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":238.98,"discounted_cash":238.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":477.95,"discounted_cash":477.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"LURASIDONE HCL 40 MG PO TABS [107668]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-304-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.06,"discounted_cash":101.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":101.06,"discounted_cash":101.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":202.12,"discounted_cash":202.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"MAGNESIUM 4 GM/100 ML INFUSION [408129179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-6729-23","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LOXAPINE SUCCINATE 5 MG PO CAPS [4601]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1394-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-361-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN POTASSIUM 25 MG PO TABS [14823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-673-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN POTASSIUM 100 MG PO TABS [22588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-137-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN POTASSIUM 100 MG PO TABS [22588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-203-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN POTASSIUM 100 MG PO TABS [22588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-203-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-202-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOXAPINE SUCCINATE 25 MG PO CAPS [4600]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1396-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOXAPINE SUCCINATE 10 MG PO CAPS [4599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1395-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % OP SUSP [22710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82260-299-05","type":"NDC"}],"standard_charges":[{"gross_charge":687.06,"discounted_cash":687.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LOTEPREDNOL ETABONATE 0.5 % OP SUSP [22710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-299-05","type":"NDC"}],"standard_charges":[{"gross_charge":1597.29,"discounted_cash":1597.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LOSARTAN POTASSIUM 50 MG PO TABS [14824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-377-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY [149049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"62332-650-10","type":"NDC"}],"standard_charges":[{"gross_charge":552.51,"discounted_cash":552.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1105.01,"discounted_cash":1105.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOTHYROXINE SODIUM 50 MCG PO TABS [4421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-966-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-204-20","type":"NDC"}],"standard_charges":[{"gross_charge":65.72,"discounted_cash":65.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":131.44,"discounted_cash":131.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-204-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.26,"discounted_cash":81.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":162.52,"discounted_cash":162.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70710-1359-1","type":"NDC"}],"standard_charges":[{"gross_charge":122.24,"discounted_cash":122.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":244.48,"discounted_cash":244.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":61.12,"discounted_cash":61.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"31722-203-32","type":"NDC"}],"standard_charges":[{"gross_charge":47.48,"discounted_cash":47.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":94.96,"discounted_cash":94.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"31722-203-20","type":"NDC"}],"standard_charges":[{"gross_charge":59.66,"discounted_cash":59.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":119.32,"discounted_cash":119.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-791-20","type":"NDC"}],"standard_charges":[{"gross_charge":53.3,"discounted_cash":53.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":106.6,"discounted_cash":106.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN [96972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70710-1359-6","type":"NDC"}],"standard_charges":[{"gross_charge":206.18,"discounted_cash":206.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":412.36,"discounted_cash":412.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":103.09,"discounted_cash":103.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACTASE 3000 UNITS PO TABS [22469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5224-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9000 UNITS"}]},{"description":"LACTASE 3000 UNITS PO TABS [22469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0080-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9000 UNITS"}]},{"description":"LACOSAMIDE 50 MG PO TABS [96968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-676-57","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 50 MG PO TABS [96968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-676-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 50 MG PO TABS [96968]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7244-68","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN [105482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-627-26","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":33.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":66.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":16.5,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-162-26","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-162-14","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62332-601-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-701-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76045-104-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":45.06,"discounted_cash":45.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72611-722-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-118-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN [97716]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-119-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"K-Y LUBRICATING EX GEL [4171]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"6798-1089-12","type":"NDC"}],"standard_charges":[{"gross_charge":21.57,"discounted_cash":21.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72611-734-01","type":"NDC"}],"standard_charges":[{"gross_charge":109.72,"discounted_cash":109.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000-322-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN [10372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000-322-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LABETALOL HCL 200 MG PO TABS [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-382-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL HCL 200 MG PO TABS [10374]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7110-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL HCL 100 MG PO TABS [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-381-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LABETALOL HCL 100 MG PO TABS [10373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-381-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LACTATED RINGERS (AMNIO BOLUS) SOLN [40890012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0117-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS [21810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-416-25","type":"NDC"}],"standard_charges":[{"gross_charge":44.71,"discounted_cash":44.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS [21810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-597-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS [21810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-506-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LAMIVUDINE 150 MG PO TABS [15880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-710-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LAMIVUDINE 100 MG PO TABS [24419]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3250-6","type":"NDC"}],"standard_charges":[{"gross_charge":46.41,"discounted_cash":46.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":92.81,"discounted_cash":92.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":139.22,"discounted_cash":139.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LAMIVUDINE 100 MG PO TABS [24419]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0662-00","type":"NDC"}],"standard_charges":[{"gross_charge":90.92,"discounted_cash":90.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":181.84,"discounted_cash":181.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":272.76,"discounted_cash":272.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"LAMIVUDINE 10 MG/ML PO SOLN [15881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-274-24","type":"NDC"}],"standard_charges":[{"gross_charge":332.64,"discounted_cash":332.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"LAMIVUDINE 10 MG/ML PO SOLN [15881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-566-70","type":"NDC"}],"standard_charges":[{"gross_charge":498.24,"discounted_cash":498.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"LACTULOSE 200 GM/300ML RE SOLN [40838245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-9999-45","type":"NDC"}],"standard_charges":[{"gross_charge":27.8,"discounted_cash":27.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS [21810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-416-95","type":"NDC"}],"standard_charges":[{"gross_charge":44.64,"discounted_cash":44.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-003-94","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LAMOTRIGINE 100 MG PO TABS [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4131-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN [87861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1932","type":"HCPCS"},{"code":"69097-870-67","type":"NDC"}],"standard_charges":[{"gross_charge":18994.96,"discounted_cash":18994.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":9497.48,"discounted_cash":9497.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":14246.22,"discounted_cash":14246.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"LANOLIN-PETROLATUM 15.5-53.4 % EX OINT [131434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65197-400-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"LAMOTRIGINE 25 MG PO TABS [13981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4130-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"LAMOTRIGINE 100 MG PO TABS [13982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-701-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1154-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LACTATED RINGERS IV BOLUS [400296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0117-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV BOLUS [400296]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0117-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV SOLN [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7750-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN [38245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0873-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"LACTULOSE 10 G PO PACK [18334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66220-719-30","type":"NDC"}],"standard_charges":[{"gross_charge":57.91,"discounted_cash":57.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"LACTULOSE 10 G PO PACK [18334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66220-719-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"LACTOBACILLUS PO PACK [105379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71351-013-99","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"LACTOBACILLUS PO PACK [105379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71351-013-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"LACTATED RINGERS IV SOLN NON-DEHP [4082004318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7750-20","type":"NDC"}],"standard_charges":[{"gross_charge":128.01,"discounted_cash":128.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"LACTATED RINGERS IV SOLN [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-479-05","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTATED RINGERS IV SOLN [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-164-26","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTATED RINGERS IV SOLN [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-164-25","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV SOLN [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0990-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTATED RINGERS IV SOLN [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0990-7953-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV SOLN [4318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7750-07","type":"NDC"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-701-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG PO TB24 [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG PO TABS [10357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81665-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 30 MG PO TB24 [24521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-539-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG PO TABS [10357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE MONONITRATE 20 MG PO TABS [10357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2620-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-083-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG PO TB24 [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-176-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISRADIPINE 2.5 MG PO CAPS [10362]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-807-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISRADIPINE 2.5 MG PO CAPS [10362]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64850-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN [10358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-220-05","type":"NDC"}],"standard_charges":[{"gross_charge":4087.28,"discounted_cash":4087.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":4087.28,"discounted_cash":4087.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN [10358]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-240-05","type":"NDC"}],"standard_charges":[{"gross_charge":218.39,"discounted_cash":218.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"},{"gross_charge":218.39,"discounted_cash":218.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ISOSORBIDE MONONITRATE ER 60 MG PO TB24 [24268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-540-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-083-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG PO TABS [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-374-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG PO TABS [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6619-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 10 MG PO TABS [4064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1556-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN [4034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"83634-303-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN [4034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69918-735-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN [4034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69918-735-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"ISOPROPYL ALCOHOL 70 % N/A SOLN [4030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0869-0810-43","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ITRACONAZOLE 10 MG/ML PO SOLN [19928]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10147-0150-1","type":"NDC"}],"standard_charges":[{"gross_charge":172.92,"discounted_cash":172.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1772-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-375-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-449-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-449-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6620-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ISOSORBIDE DINITRATE 20 MG PO TABS [4065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1695-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ITRACONAZOLE 100 MG PO CAPS [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-450-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3795-19","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":62.1,"discounted_cash":62.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0072-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 10 MG PO TABS [10371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-388-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETOROLAC TROMETHAMINE 10 MG PO TABS [10371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1134-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-126-05","type":"NDC"}],"standard_charges":[{"gross_charge":35.7,"discounted_cash":35.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-1003-2","type":"NDC"}],"standard_charges":[{"gross_charge":383.34,"discounted_cash":383.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-1003-1","type":"NDC"}],"standard_charges":[{"gross_charge":32.88,"discounted_cash":32.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42571-137-25","type":"NDC"}],"standard_charges":[{"gross_charge":35.89,"discounted_cash":35.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN [19733]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-2181-05","type":"NDC"}],"standard_charges":[{"gross_charge":1588.05,"discounted_cash":1588.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOCONAZOLE 200 MG PO TABS [10369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4026-6","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"KETOCONAZOLE 200 MG PO TABS [10369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"35573-433-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6042-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6042-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-162-43","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-162-23","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-162-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62332-600-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62332-600-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50090-5428-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN [22473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"KETOCONAZOLE 2 % EX SHAM [14132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-465-64","type":"NDC"}],"standard_charges":[{"gross_charge":61.92,"discounted_cash":61.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"JETCO CANNULA 4 IN 10 [40800060]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999345610","type":"NDC"}],"standard_charges":[{"gross_charge":20.19,"discounted_cash":20.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"IVERMECTIN 3 MG PO TABS [25820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-806-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.65,"discounted_cash":39.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"IVERMECTIN 3 MG PO TABS [25820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0032-20","type":"NDC"}],"standard_charges":[{"gross_charge":58.11,"discounted_cash":58.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"IVABRADINE HCL 5 MG PO TABS [128268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1471-6","type":"NDC"}],"standard_charges":[{"gross_charge":19.67,"discounted_cash":19.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":39.34,"discounted_cash":39.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":59.01,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"IVABRADINE HCL 5 MG PO TABS [128268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513-800-60","type":"NDC"}],"standard_charges":[{"gross_charge":30.84,"discounted_cash":30.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":61.68,"discounted_cash":61.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":92.52,"discounted_cash":92.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"IVABRADINE HCL 5 MG PO TABS [128268]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-362-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"ITRACONAZOLE 100 MG PO CAPS [10364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-450-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN [9800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7645-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN [9800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0663-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN [9801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0671-04","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KETOCONAZOLE 2 % EX CREA [10368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1298-2","type":"NDC"}],"standard_charges":[{"gross_charge":565.74,"discounted_cash":565.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA [10368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1298-1","type":"NDC"}],"standard_charges":[{"gross_charge":37.62,"discounted_cash":37.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA [10368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0099-15","type":"NDC"}],"standard_charges":[{"gross_charge":33.12,"discounted_cash":33.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"KETOCONAZOLE 2 % EX CREA [10368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3219-15","type":"NDC"}],"standard_charges":[{"gross_charge":147.69,"discounted_cash":147.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"KETAMINE HCL 2 MG/ML INFUSION ANES [4084238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-001-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"KETAMINE HCL 2 MG/ML INFUSION ANES [4084238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-001-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"KETAMINE HCL 10 MG/ML IJ SOLN [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-438-10","type":"NDC"}],"standard_charges":[{"gross_charge":111.28,"discounted_cash":111.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETAMINE HCL 10 MG/ML IJ SOLN [4236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-438-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.99,"discounted_cash":92.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KCL IN DEXTROSE-NACL 40-5-0.9 MEQ/L-%-% IV SOLN [9796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7109-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 40-5-0.9 MEQ/L-%-% IV SOLN [9796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0807-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN [9807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0675-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 30-5-0.45 MEQ/L-%-% IV SOLN [9804]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7903-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-118-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.24,"discounted_cash":66.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0803-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN [9795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7652-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.225 MEQ/L-%-% IV SOLN [27166]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7901-09","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LANREOTIDE ACETATE 60 MG/0.2ML SC SOLN [88570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054-1060-3","type":"NDC"}],"standard_charges":[{"gross_charge":4584.92,"discounted_cash":4584.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6981-32","type":"NDC"}],"standard_charges":[{"gross_charge":54.51,"discounted_cash":54.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":109.01,"discounted_cash":109.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1834-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-649-07","type":"NDC"}],"standard_charges":[{"gross_charge":426.9,"discounted_cash":426.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":426.9,"discounted_cash":426.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":426.9,"discounted_cash":426.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG IV SOLR [113018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-468-10","type":"NDC"}],"standard_charges":[{"gross_charge":90.44,"discounted_cash":90.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":180.87,"discounted_cash":180.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":271.3,"discounted_cash":271.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVONORGESTREL 20 MCG/DAY IU IUD [148001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50419-423-01","type":"NDC"}],"standard_charges":[{"gross_charge":4548.79,"discounted_cash":4548.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 19.5 MG IU IUD [132534]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50419-424-01","type":"NDC"}],"standard_charges":[{"gross_charge":4548.79,"discounted_cash":4548.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 13.5 MG IU IUD [119914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50419-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":3607.26,"discounted_cash":3607.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVONORGESTREL 1.5 MG PO TABS [99445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68180-852-11","type":"NDC"}],"standard_charges":[{"gross_charge":13.29,"discounted_cash":13.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOMILNACIPRAN HCL ER 40 MG PO CP24 [124323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2240-30","type":"NDC"}],"standard_charges":[{"gross_charge":103.7,"discounted_cash":103.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-437-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVONORGESTREL 20.1 MCG/DAY IU IUD [148002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0023-5858-01","type":"NDC"}],"standard_charges":[{"gross_charge":5981.71,"discounted_cash":5981.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-3285-46","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":13.68,"discounted_cash":13.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":16.41,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":21.88,"discounted_cash":21.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 100 MCG PO TABS [4423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1834-7","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"36000-296-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN [108120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4444-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-436-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"36000-295-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN [113553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567-501-02","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN [113553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567-501-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN [113553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0264-5009-90","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN [113557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"70860-604-41","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN [113557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567-503-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN [113557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567-503-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN [113557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789-330-15","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN [113557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789-330-08","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN [113556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567-502-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN [113556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567-502-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN [113556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789-220-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN [113556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789-220-08","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM ER 750 MG PO TB24 [97382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-114-06","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN [113553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150-246-47","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVOBUNOLOL HCL 0.5 % OP SOLN [10394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-505-05","type":"NDC"}],"standard_charges":[{"gross_charge":89.55,"discounted_cash":89.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVOCARNITINE 330 MG PO TABS [20952]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-492-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 330 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 660 MG"},{"gross_charge":13.72,"discounted_cash":13.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 990 MG"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN [108119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9316-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN [108118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-132-81","type":"NDC"}],"standard_charges":[{"gross_charge":1485.7,"discounted_cash":1485.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"LEVOFLOXACIN 500 MG PO TABS [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-537-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 500 MG PO TABS [18919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6352-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 250 MG PO TABS [18918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6351-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOFLOXACIN 250 MG PO TABS [18918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5790-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOTHYROXINE SODIUM 112 MCG PO TABS [10404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-452-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":13.68,"discounted_cash":13.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":16.41,"discounted_cash":16.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":21.88,"discounted_cash":21.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-4341-90","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":54.88,"discounted_cash":54.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 200 MCG PO TABS [4426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1840-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 200 MCG PO TABS [4426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-975-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 25 MCG PO TABS [4420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1830-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":54.88,"discounted_cash":54.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 112 MCG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVETIRACETAM ER 500 MG PO TB24 [93834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-573-86","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1838-7","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 137 MCG PO TABS [10405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72305-137-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":13.42,"discounted_cash":13.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":17.89,"discounted_cash":17.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 125 MCG PO TABS [4424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1836-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":14.7,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":19.6,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-973-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LEVOTHYROXINE SODIUM 150 MCG PO TABS [4425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1838-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MCG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MCG"}]},{"description":"LANSINOH LANOLIN EX CREA [141653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"44677-10202","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 G"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323-400-44","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LETROZOLE 2.5 MG PO TABS [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-759-33","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG PO TABS [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-476-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG PO TABS [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-476-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG PO TABS [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-034-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETROZOLE 2.5 MG PO TABS [21509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7620-56","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"LETERMOVIR 480 MG PO TABS [134070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-3076-04","type":"NDC"}],"standard_charges":[{"gross_charge":1817.48,"discounted_cash":1817.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MG"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR [4392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-528-10","type":"NDC"}],"standard_charges":[{"gross_charge":48.82,"discounted_cash":48.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"LETERMOVIR 480 MG PO TABS [134070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-3076-03","type":"NDC"}],"standard_charges":[{"gross_charge":1817.48,"discounted_cash":1817.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MG"}]},{"description":"LEFLUNOMIDE 10 MG PO TABS [23872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-2502-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"LATANOPROSTENE BUNOD 0.024 % OP SOLN [133941]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-504-05","type":"NDC"}],"standard_charges":[{"gross_charge":2719.0,"discounted_cash":2719.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LATANOPROSTENE BUNOD 0.024 % OP SOLN [133941]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-504-02","type":"NDC"}],"standard_charges":[{"gross_charge":1439.75,"discounted_cash":1439.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-421-03","type":"NDC"}],"standard_charges":[{"gross_charge":22.07,"discounted_cash":22.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.63,"discounted_cash":21.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN [18621]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64980-516-25","type":"NDC"}],"standard_charges":[{"gross_charge":64.01,"discounted_cash":64.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR [4392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-161-20","type":"NDC"}],"standard_charges":[{"gross_charge":55.89,"discounted_cash":55.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9368-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.18,"discounted_cash":51.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR [15426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-710-50","type":"NDC"}],"standard_charges":[{"gross_charge":53.44,"discounted_cash":53.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG PO TABS [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-582-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.26,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.88,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":26.51,"discounted_cash":26.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":33.14,"discounted_cash":33.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG PO TABS [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0485-27","type":"NDC"}],"standard_charges":[{"gross_charge":45.2,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":45.2,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":45.2,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":45.2,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":45.2,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG PO TABS [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4499-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.73,"discounted_cash":26.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":40.09,"discounted_cash":40.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":53.45,"discounted_cash":53.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":66.81,"discounted_cash":66.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":13.37,"discounted_cash":13.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LANTHANUM CARBONATE 500 MG PO CHEW [39975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66993-422-85","type":"NDC"}],"standard_charges":[{"gross_charge":95.55,"discounted_cash":95.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":23.89,"discounted_cash":23.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":47.78,"discounted_cash":47.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":71.66,"discounted_cash":71.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-771-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.42,"discounted_cash":22.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":44.84,"discounted_cash":44.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-895-78","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-895-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-543-30","type":"NDC"}],"standard_charges":[{"gross_charge":40.63,"discounted_cash":40.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":81.26,"discounted_cash":81.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-543-11","type":"NDC"}],"standard_charges":[{"gross_charge":82.97,"discounted_cash":82.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":165.94,"discounted_cash":165.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-560-79","type":"NDC"}],"standard_charges":[{"gross_charge":34.8,"discounted_cash":34.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":69.59,"discounted_cash":69.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-560-78","type":"NDC"}],"standard_charges":[{"gross_charge":26.77,"discounted_cash":26.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":53.54,"discounted_cash":53.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 15 MG PO TBDD [140791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-771-77","type":"NDC"}],"standard_charges":[{"gross_charge":18.74,"discounted_cash":18.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":37.47,"discounted_cash":37.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG PO TABS [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-582-05","type":"NDC"}],"standard_charges":[{"gross_charge":44.78,"discounted_cash":44.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":44.78,"discounted_cash":44.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":44.78,"discounted_cash":44.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.78,"discounted_cash":44.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":44.78,"discounted_cash":44.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LANSOPRAZOLE 3 MG/ML PO SUSP [113441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65628-080-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"LANTHANUM CARBONATE 500 MG PO CHEW [39975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66993-422-47","type":"NDC"}],"standard_charges":[{"gross_charge":111.95,"discounted_cash":111.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":27.99,"discounted_cash":27.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":55.98,"discounted_cash":55.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":83.97,"discounted_cash":83.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD [140792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-772-77","type":"NDC"}],"standard_charges":[{"gross_charge":14.96,"discounted_cash":14.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":29.92,"discounted_cash":29.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD [140792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-772-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":22.41,"discounted_cash":22.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD [140792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-561-79","type":"NDC"}],"standard_charges":[{"gross_charge":17.02,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":34.04,"discounted_cash":34.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 30 MG PO TBDD [140792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-561-78","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":20.58,"discounted_cash":20.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LANSOPRAZOLE 30 MG PO CPDR [27692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70700-263-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LEVETIRACETAM 250 MG PO TABS [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7123-61","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 250 MG PO TABS [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6051-61","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN [36590]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-249-77","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO [43472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-510-01","type":"NDC"}],"standard_charges":[{"gross_charge":411.65,"discounted_cash":411.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO [43472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2927-54","type":"NDC"}],"standard_charges":[{"gross_charge":544.74,"discounted_cash":544.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU [24916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76204-900-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU [24916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76204-900-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5ML IN NEBU [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65862-942-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5ML IN NEBU [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0378-6993-93","type":"NDC"}],"standard_charges":[{"gross_charge":31.7,"discounted_cash":31.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVETIRACETAM 250 MG PO TABS [26816]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-245-08","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323-400-41","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0409-1886-22","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN [77195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"0409-1886-02","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG PO TABS [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-403-07","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG PO TABS [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-403-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVETIRACETAM 500 MG PO TABS [26817]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-537-12","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5ML IN NEBU [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-4147-56","type":"NDC"}],"standard_charges":[{"gross_charge":12.32,"discounted_cash":12.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76204-800-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEUCOVORIN CALCIUM 5 MG PO TABS [4398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8496-19","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 5 MG PO TABS [4398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4496-13","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG PO TABS [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-227-94","type":"NDC"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.58,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":28.77,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.96,"discounted_cash":35.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEUCOVORIN CALCIUM 25 MG PO TABS [4397]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-227-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":21.58,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":28.77,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":35.96,"discounted_cash":35.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5ML IN NEBU [39278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-4147-19","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":24.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"LEUCOVORIN CALCIUM 5 MG PO TABS [4398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-581-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU [24915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76204-800-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.63 MG"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG SC KIT [32893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62935-756-80","type":"NDC"}],"standard_charges":[{"gross_charge":846.5,"discounted_cash":846.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG SC KIT [32893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62935-753-75","type":"NDC"}],"standard_charges":[{"gross_charge":864.93,"discounted_cash":864.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"LEUPROLIDE ACETATE 7.5 MG IM KIT [10392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0074-3642-03","type":"NDC"}],"standard_charges":[{"gross_charge":1146.7,"discounted_cash":1146.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"LEUPROLIDE ACETATE 3.75 MG IM KIT [13691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0074-3641-03","type":"NDC"}],"standard_charges":[{"gross_charge":6567.82,"discounted_cash":6567.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT [40801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62935-461-50","type":"NDC"}],"standard_charges":[{"gross_charge":4901.38,"discounted_cash":4901.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT [110751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0074-3473-03","type":"NDC"}],"standard_charges":[{"gross_charge":3903.45,"discounted_cash":3903.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) 30 MG SC KIT [35236]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62935-306-40","type":"NDC"}],"standard_charges":[{"gross_charge":3254.0,"discounted_cash":3254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT [21108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0074-3683-03","type":"NDC"}],"standard_charges":[{"gross_charge":5633.0,"discounted_cash":5633.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT [21045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0074-3346-03","type":"NDC"}],"standard_charges":[{"gross_charge":3352.1,"discounted_cash":3352.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"}]},{"description":"LEUPROLIDE ACETATE (3 MONTH) 11.25 MG IM KIT [21044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0074-3663-03","type":"NDC"}],"standard_charges":[{"gross_charge":19672.56,"discounted_cash":19672.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.25 MG"}]},{"description":"LEUCOVORIN CALCIUM 5 MG PO TABS [4398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-184-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY [149049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"62332-650-05","type":"NDC"}],"standard_charges":[{"gross_charge":552.49,"discounted_cash":552.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1104.98,"discounted_cash":1104.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5ML PO LIQD [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-1004-8","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5ML PO LIQD [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-0025-8","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5ML PO LIQD [9774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-0025-4","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5ML PO SUER [130424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-141-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.83,"discounted_cash":6.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 148 ML"}]},{"description":"DEXTRAN 40 IN D5W 10 % IV SOLN [9759]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7418-03","type":"NDC"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":202.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXRAZOXANE HCL 500 MG IV SOLR [139423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-437-01","type":"NDC"}],"standard_charges":[{"gross_charge":602.23,"discounted_cash":602.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXRAZOXANE HCL 500 MG IV SOLR [139423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"47781-578-07","type":"NDC"}],"standard_charges":[{"gross_charge":1618.19,"discounted_cash":1618.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEXMEDETOMIDINE HCL-DEXTROSE 400MCG/100ML -5% IV SOLN [138584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"44567-603-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXMEDETOMIDINE HCL IN NACL 400 MCG/100ML IV SOLN [121673]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1660-10","type":"NDC"}],"standard_charges":[{"gross_charge":248.2,"discounted_cash":248.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5ML PO SYRP [27345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1184-97","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"DEXTROMETHORPHAN-QUINIDINE 20-10 MG PO CAPS [107672]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64597-301-60","type":"NDC"}],"standard_charges":[{"gross_charge":156.81,"discounted_cash":156.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"DEXTROSE 10 % IV SOLN - MAINT [4082902357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0023-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IV SOLN - MAINT [4082902364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IV SOLN - MAINT [4082902364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 250 MG/ML IV SOLN [2361]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1775-40","type":"NDC"}],"standard_charges":[{"gross_charge":296.8,"discounted_cash":296.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"}]},{"description":"DEXTROSE 250 MG/ML IV SOLN [2361]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1775-10","type":"NDC"}],"standard_charges":[{"gross_charge":563.2,"discounted_cash":563.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"}]},{"description":"DEXTROSE 10 % IV SOLN BOLUS [400302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0023-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 10 % IV SOLN [2357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7930-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 10 % IV SOLN [2357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7930-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 10 % IV SOLN [2357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7930-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE 10 % IV SOLN [2357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0023-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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[145186]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1600-44","type":"NDC"}],"standard_charges":[{"gross_charge":70.33,"discounted_cash":70.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-505-03","type":"NDC"}],"standard_charges":[{"gross_charge":49.14,"discounted_cash":49.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-505-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-165-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN [125097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-165-26","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN [125098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-165-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN [2335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24208-720-02","type":"NDC"}],"standard_charges":[{"gross_charge":267.39,"discounted_cash":267.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN [117428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069-021-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN [117428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.42,"discounted_cash":48.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN [117428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150-304-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN [117428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150-304-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXTROSE 5 % IV SOLN [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN [2332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70518-2936-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66794-230-42","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66794-230-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-146-25","type":"NDC"}],"standard_charges":[{"gross_charge":57.36,"discounted_cash":57.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-239-93","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN [123758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9532-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN WRAPPER [4082332]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76045-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXTROSE 5 % IV SOLN [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-11","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN BOLUS [400297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0125-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN [9788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0990-7929-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN [9788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0990-7929-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN BOLUS [400297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0125-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN [9788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7751-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 70 % IV SOLN [2367]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-7387-50","type":"NDC"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"DEXTROSE 50 % IV SOLN [2365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-4902-34","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 50 % IV SOLN [2365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3302-1","type":"NDC"}],"standard_charges":[{"gross_charge":242.6,"discounted_cash":242.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":72.78,"discounted_cash":72.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":121.3,"discounted_cash":121.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":60.65,"discounted_cash":60.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":121.3,"discounted_cash":121.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE-NACL 5-0.2 % IV SOLN BOLUS [134211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0077-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.2 % IV SOLN - MAINT [4089009812]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7616-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 2.5-0.45 % IV SOLN [9811]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0073-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 10-0.2 % IV SOLN [9808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7623-20","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DEXTROSE-NACL 5-0.9 % IV SOLN BOLUS [400294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0089-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-NACL 5-0.9 % IV SOLN BOLUS [400294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0089-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-NACL 5-0.45 % IV SOLN BOLUS [400295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0085-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-NACL 5-0.45 % IV SOLN BOLUS [400295]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-0085-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXAMETHASONE SOD PHOS INTRAVITREAL INJ 0.4 MG/0.1 ML SYRINGE [4081158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-66","type":"NDC"}],"standard_charges":[{"gross_charge":45.1,"discounted_cash":45.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"DEXTROSE 50 % IV SOLN [2365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4902-34","type":"NDC"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":236.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":118.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 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[2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7923-37","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7923-36","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IV SOLN [2364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0017-48","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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[76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69097-285-37","type":"NDC"}],"standard_charges":[{"gross_charge":5051.6,"discounted_cash":5051.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG IV SOLR [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0894","type":"HCPCS"},{"code":"68001-573-41","type":"NDC"}],"standard_charges":[{"gross_charge":449.23,"discounted_cash":449.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG IV SOLR [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59148-046-70","type":"NDC"}],"standard_charges":[{"gross_charge":1146.06,"discounted_cash":1146.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG IV SOLR [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55111-556-10","type":"NDC"}],"standard_charges":[{"gross_charge":257.47,"discounted_cash":257.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DECITABINE 50 MG IV SOLR [76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0893","type":"HCPCS"},{"code":"47335-361-41","type":"NDC"}],"standard_charges":[{"gross_charge":641.83,"discounted_cash":641.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFERASIROX 360 MG PO TABS [128160]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0656-15","type":"NDC"}],"standard_charges":[{"gross_charge":229.91,"discounted_cash":229.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DEFEROXAMINE MESYLATE 500 MG IJ SOLR [9723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2336-01","type":"NDC"}],"standard_charges":[{"gross_charge":155.08,"discounted_cash":155.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":77.54,"discounted_cash":77.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DEGARELIX ACETATE (240 MG DOSE) 120 MG/VIAL SC SOLR [142315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9155","type":"HCPCS"},{"code":"55566-8403-1","type":"NDC"}],"standard_charges":[{"gross_charge":5743.81,"discounted_cash":5743.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG PO TABS [16053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-732-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MCG"}]},{"description":"DESMOPRESSIN ACE SPRAY REFRIG 0.01 % NA SOLN [27770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24208-342-05","type":"NDC"}],"standard_charges":[{"gross_charge":1042.62,"discounted_cash":1042.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DESIPRAMINE HCL 25 MG PO TABS [2286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-113-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DENOSUMAB 60 MG/ML SC SOSY [139446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513-710-21","type":"NDC"}],"standard_charges":[{"gross_charge":5808.03,"discounted_cash":5808.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DENOSUMAB 60 MG/ML SC SOSY [139446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513-710-01","type":"NDC"}],"standard_charges":[{"gross_charge":6530.11,"discounted_cash":6530.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 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[76364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-427-37","type":"NDC"}],"standard_charges":[{"gross_charge":257.47,"discounted_cash":257.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAUNORUBICIN-CYTARABINE LIPO 44-100 MG IV SUSR [136490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J9153","type":"HCPCS"},{"code":"68727-745-01","type":"NDC"}],"standard_charges":[{"gross_charge":29067.75,"discounted_cash":29067.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN [137205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42658-021-02","type":"NDC"}],"standard_charges":[{"gross_charge":267.32,"discounted_cash":267.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN [137205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42658-021-01","type":"NDC"}],"standard_charges":[{"gross_charge":381.01,"discounted_cash":381.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DARIFENACIN HYDROBROMIDE ER 7.5 MG PO TB24 [40402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-431-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"DARIFENACIN HYDROBROMIDE ER 7.5 MG PO TB24 [40402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0430-0170-23","type":"NDC"}],"standard_charges":[{"gross_charge":154.86,"discounted_cash":154.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":77.43,"discounted_cash":77.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN [143030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"57894-503-01","type":"NDC"}],"standard_charges":[{"gross_charge":37578.72,"discounted_cash":37578.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1800 MG"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"71839-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":125.54,"discounted_cash":125.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0872","type":"HCPCS"},{"code":"70594-034-02","type":"NDC"}],"standard_charges":[{"gross_charge":96.01,"discounted_cash":96.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70594-034-01","type":"NDC"}],"standard_charges":[{"gross_charge":96.01,"discounted_cash":96.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"60505-6229-4","type":"NDC"}],"standard_charges":[{"gross_charge":116.68,"discounted_cash":116.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"43598-413-11","type":"NDC"}],"standard_charges":[{"gross_charge":119.64,"discounted_cash":119.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR [36989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0878","type":"HCPCS"},{"code":"0409-2757-01","type":"NDC"}],"standard_charges":[{"gross_charge":171.12,"discounted_cash":171.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPSONE 25 MG PO TABS [2132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-135-20","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 25 MG PO TABS [2132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49938-102-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DARUNAVIR 600 MG PO TABS [147691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0480-7736-06","type":"NDC"}],"standard_charges":[{"gross_charge":65.36,"discounted_cash":65.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":87.15,"discounted_cash":87.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DARUNAVIR 600 MG PO TABS [147691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-562-01","type":"NDC"}],"standard_charges":[{"gross_charge":224.58,"discounted_cash":224.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":449.15,"discounted_cash":449.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DAUNORUBICIN HCL 20 MG/4ML IV SOLN [137205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9551-01","type":"NDC"}],"standard_charges":[{"gross_charge":449.17,"discounted_cash":449.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DASATINIB 70 MG PO TABS [76719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-0524-11","type":"NDC"}],"standard_charges":[{"gross_charge":2719.46,"discounted_cash":2719.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2719.46,"discounted_cash":2719.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"},{"gross_charge":1359.73,"discounted_cash":1359.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"DASATINIB 50 MG PO TABS [76718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0003-0528-11","type":"NDC"}],"standard_charges":[{"gross_charge":2885.33,"discounted_cash":2885.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":4328.0,"discounted_cash":4328.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"},{"gross_charge":2885.33,"discounted_cash":2885.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"DARUN-COBIC-EMTRICIT-TENOFAF 800-150-200-10 MG PO TABS [137569]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-800-30","type":"NDC"}],"standard_charges":[{"gross_charge":929.68,"discounted_cash":929.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"DARUNAVIR 800 MG PO TABS [147692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-346-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DARUNAVIR 800 MG PO TABS [147692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-566-30","type":"NDC"}],"standard_charges":[{"gross_charge":449.15,"discounted_cash":449.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":449.15,"discounted_cash":449.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DARUNAVIR 600 MG PO TABS [147691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-345-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG PO TABS [16053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-326-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MCG"}]},{"description":"DEXAMETHASONE 2 MG PO TABS [2326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219-2056-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DEXAMETHASONE 2 MG PO TABS [2326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"0054-8176-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE 2 MG PO TABS [2326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8176-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DEXAMETHASONE 2 MG PO TABS [2326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"0054-4183-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE 2 MG PO TABS [2326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4183-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DEXAMETHASONE 1 MG/ML PO CONC MOUTHWASH [4082017947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"9999-3176-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.34,"discounted_cash":44.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXAMETHASONE 1 MG/ML PO CONC MOUTHWASH [4082017947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"0054-3176-44","type":"NDC"}],"standard_charges":[{"gross_charge":44.34,"discounted_cash":44.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":133.02,"discounted_cash":133.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":17.74,"discounted_cash":17.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"DEXAMETHASONE 2 MG PO TABS [2326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"60219-2056-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE 4 MG PO TABS [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-403-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DEXAMETHASONE 4 MG PO TABS [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"66993-730-51","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE 4 MG PO TABS [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-730-51","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DEXAMETHASONE 4 MG PO TABS [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"47781-914-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE 4 MG PO TABS [2327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-914-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DEXAMETHASONE 1 MG/ML PO CONC MOUTHWASH [4082017947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3176-44","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 25 MG PO TB24 [128162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-036-04","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 25 MG PO TB24 [128162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0603-13","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESONIDE 0.05 % EX CREA [2291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1280-1","type":"NDC"}],"standard_charges":[{"gross_charge":40.14,"discounted_cash":40.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN [145172]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69918-899-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918-901-10","type":"NDC"}],"standard_charges":[{"gross_charge":856.42,"discounted_cash":856.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG PO TABS [16053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69918-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MCG"}]},{"description":"DESMOPRESSIN ACETATE 0.2 MG PO TABS [16053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68084-604-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MCG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MCG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24 [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0400-13","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24 [91073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-311-33","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DEXAMETHASONE 0.5 MG/5ML PO ELIX [2319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"54879-003-08","type":"NDC"}],"standard_charges":[{"gross_charge":237.48,"discounted_cash":237.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"DEXAMETHASONE 0.5 MG PO TABS [2322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"60505-6249-1","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE 0.5 MG PO TABS [2322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-6249-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DEXAMETHASONE 0.5 MG PO TABS [2322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J8540","type":"HCPCS"},{"code":"0054-8179-25","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DEXAMETHASONE 0.5 MG PO TABS [2322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8179-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24 [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-831-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24 [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-994-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":28.59,"discounted_cash":28.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 420 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24 [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-249-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":28.59,"discounted_cash":28.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 420 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24 [29274]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-250-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657-528-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"DINOPROSTONE 10 MG VA INST [27467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55566-2800-1","type":"NDC"}],"standard_charges":[{"gross_charge":3171.87,"discounted_cash":3171.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"DINOPROSTONE 0.5 MG/3GM VA GEL [9874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-3359-01","type":"NDC"}],"standard_charges":[{"gross_charge":1481.78,"discounted_cash":1481.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DIMETHYL SULFOXIDE 50 % IS SOLN [9873]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-177-50","type":"NDC"}],"standard_charges":[{"gross_charge":4339.9,"discounted_cash":4339.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DIMERCAPROL 100 MG/ML IM SOLN [9872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"17478-526-03","type":"NDC"}],"standard_charges":[{"gross_charge":1035.11,"discounted_cash":1035.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24 [29276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-721-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.7,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24 [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-249-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":28.59,"discounted_cash":28.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 420 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24 [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-026-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24 [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-026-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24 [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-829-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24 [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-248-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-267-42","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24 [29272]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-027-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":28.59,"discounted_cash":28.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 420 MG"}]},{"description":"DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24 [29270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-718-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-267-56","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-152-17","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-7123-89","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-7123-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX SODIUM 125 MG PO CSDR [130453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-115-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"DISULFIRAM 250 MG PO TABS [2540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62135-431-30","type":"NDC"}],"standard_charges":[{"gross_charge":57.16,"discounted_cash":57.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":114.32,"discounted_cash":114.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DISULFIRAM 250 MG PO TABS [2540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47781-607-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DISTILLED WATER PO LIQD [17336]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"79765-02000","type":"NDC"}],"standard_charges":[{"gross_charge":22.71,"discounted_cash":22.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3785 ML"}]},{"description":"DISOPYRAMIDE PHOSPHATE ER 100 MG PO CP12 [2537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0025-2732-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"DISOPYRAMIDE PHOSPHATE 100 MG PO CAPS [2535]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0386-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6860-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TB24 [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0472-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TB24 [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-3826-13","type":"NDC"}],"standard_charges":[{"gross_charge":72.24,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":18.06,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":36.12,"discounted_cash":36.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":54.18,"discounted_cash":54.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM 500 MG PO TBEC [2553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-6215-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":18.32,"discounted_cash":18.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":36.63,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-797-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIVALPROEX SODIUM 250 MG PO TBEC [2552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-139-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DILTIAZEM HCL ER 60 MG PO CP12 [14100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6060-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DIPYRIDAMOLE 5 MG/ML IV SOLN [9891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-2569-41","type":"NDC"}],"standard_charges":[{"gross_charge":47.44,"discounted_cash":47.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-664-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-664-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-0376-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-0376-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG PO CAPS [2510]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2056-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG PO CAPS [2509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7237-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG PO CAPS [2509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5306-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG PO CAPS [2509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5306-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG PO CAPS [2509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0440-7425-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD [12556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-152-19","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-664-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-664-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA [16299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-5354-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIPYRIDAMOLE 25 MG PO TABS [2528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1070-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP [19451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58160-810-43","type":"NDC"}],"standard_charges":[{"gross_charge":126.12,"discounted_cash":126.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD [2515]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3194-46","type":"NDC"}],"standard_charges":[{"gross_charge":418.68,"discounted_cash":418.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":418.68,"discounted_cash":418.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-490-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS [2516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-569-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA [16299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58232-074-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA [16299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-358-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA [16299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24385-210-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN [2508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72485-101-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DILTIAZEM HCL ER 120 MG PO CP12 [11892]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-926-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.09,"discounted_cash":22.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.57,"discounted_cash":16.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DICLOFENAC EPOLAMINE 1.3 % EX PTCH [144190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82347-0405-5","type":"NDC"}],"standard_charges":[{"gross_charge":52.89,"discounted_cash":52.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"DICLOFENAC EPOLAMINE 1.3 % EX PTCH [144190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82347-0405-4","type":"NDC"}],"standard_charges":[{"gross_charge":31.1,"discounted_cash":31.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"DICLOFENAC EPOLAMINE 1.3 % EX PTCH [144190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71858-0405-4","type":"NDC"}],"standard_charges":[{"gross_charge":20.87,"discounted_cash":20.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"DIBUCAINE 1 % EX OINT [2412]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1211-95","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIBUCAINE (PERIANAL) 1 % EX OINT [142535]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-050-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"DIAZOXIDE 50 MG/ML PO SUSP [19713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0575-6200-30","type":"NDC"}],"standard_charges":[{"gross_charge":1335.06,"discounted_cash":1335.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN [19714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-457-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.45,"discounted_cash":42.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN [2401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69339-136-34","type":"NDC"}],"standard_charges":[{"gross_charge":112.9,"discounted_cash":112.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":56.45,"discounted_cash":56.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN [2401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69339-136-03","type":"NDC"}],"standard_charges":[{"gross_charge":130.04,"discounted_cash":130.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":65.02,"discounted_cash":65.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN [2401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6244-10","type":"NDC"}],"standard_charges":[{"gross_charge":113.71,"discounted_cash":113.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":56.86,"discounted_cash":56.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN [19714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-014-05","type":"NDC"}],"standard_charges":[{"gross_charge":33.84,"discounted_cash":33.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN [19714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-014-25","type":"NDC"}],"standard_charges":[{"gross_charge":19.46,"discounted_cash":19.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL [144203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0067-8152-03","type":"NDC"}],"standard_charges":[{"gross_charge":72.6,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOXACILLIN SODIUM 250 MG PO CAPS [2414]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3123-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DICLOFENAC-MISOPROSTOL 75-0.2 MG PO TBEC [18794]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-232-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"DICLOFENAC SODIUM ER 100 MG PO TB24 [27160]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DICLOFENAC SODIUM 75 MG PO TBEC [15341]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-658-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DICLOFENAC SODIUM 75 MG PO TBEC [15341]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-658-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DICLOFENAC SODIUM 50 MG PO TBEC [15340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-280-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DICLOFENAC SODIUM 50 MG PO TBEC [15340]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-202-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL [144203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-646-54","type":"NDC"}],"standard_charges":[{"gross_charge":43.2,"discounted_cash":43.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL [144203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"21922-009-09","type":"NDC"}],"standard_charges":[{"gross_charge":26.4,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL [144203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1294-97","type":"NDC"}],"standard_charges":[{"gross_charge":44.4,"discounted_cash":44.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 G"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN [2401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6244-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.64,"discounted_cash":117.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":58.82,"discounted_cash":58.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 10 MG PO TABS [2403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-286-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIATRIZOATE MEGLUMINE & SODIUM 66-10 % PO SOLN [9828]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-0445-35","type":"NDC"}],"standard_charges":[{"gross_charge":486.72,"discounted_cash":486.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"},{"gross_charge":60.84,"discounted_cash":60.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":121.68,"discounted_cash":121.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"},{"gross_charge":182.52,"discounted_cash":182.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-870-74","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-870-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0990-7941-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7610-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN [9815]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-7610-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN [9814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-869-74","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN [9814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-869-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.45 % IV SOLN [9814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0990-7926-09","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DICLOXACILLIN SODIUM 500 MG PO CAPS [2415]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3125-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"DIAZEPAM 2 MG PO TABS [2404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG SUPPOSITORIES [4082405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"99999-5880-1","type":"NDC"}],"standard_charges":[{"gross_charge":26.45,"discounted_cash":26.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG PO TABS [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-285-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG PO TABS [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-285-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 5 MG PO TABS [2405]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0140-0005-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 2 MG PO TABS [2404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-284-20","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DIAZEPAM 10 MG RE GEL [87867]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-652-20","type":"NDC"}],"standard_charges":[{"gross_charge":803.34,"discounted_cash":803.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DICYCLOMINE HCL 10 MG PO CAPS [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-0586-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-301-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-319-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-9217-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.55,"discounted_cash":49.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DILTIAZEM HCL 125 MG/25ML IV SOLN [97253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-301-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DILTIAZEM HCL 125 MG/125ML-% IV SOLN [200006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-6015-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 ML"}]},{"description":"DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"81284-411-10","type":"NDC"}],"standard_charges":[{"gross_charge":131.65,"discounted_cash":131.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":263.29,"discounted_cash":263.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0574-0850-10","type":"NDC"}],"standard_charges":[{"gross_charge":339.89,"discounted_cash":339.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":339.89,"discounted_cash":339.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0574-0850-05","type":"NDC"}],"standard_charges":[{"gross_charge":376.65,"discounted_cash":376.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":376.65,"discounted_cash":376.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9273-10","type":"NDC"}],"standard_charges":[{"gross_charge":163.61,"discounted_cash":163.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":327.22,"discounted_cash":327.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DILTIAZEM HCL 25 MG/5ML IV SOLN [97252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-301-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0318-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM HCL 60 MG PO TABS [2476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0319-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM HCL 50 MG/10ML IV SOLN [97254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-301-42","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-006-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DILTIAZEM HCL 30 MG PO TABS [2475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0023-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN [9859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9273-01","type":"NDC"}],"standard_charges":[{"gross_charge":165.27,"discounted_cash":165.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":330.53,"discounted_cash":330.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"DIGOXIN IMMUNE FAB 40 MG IV SOLR [31432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50633-121-11","type":"NDC"}],"standard_charges":[{"gross_charge":15442.76,"discounted_cash":15442.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DICYCLOMINE HCL 20 MG PO TABS [2420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-380-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-842-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":72.84,"discounted_cash":72.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-842-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":66.63,"discounted_cash":66.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58914-080-52","type":"NDC"}],"standard_charges":[{"gross_charge":522.03,"discounted_cash":522.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":522.03,"discounted_cash":522.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"17478-015-02","type":"NDC"}],"standard_charges":[{"gross_charge":123.23,"discounted_cash":123.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":246.45,"discounted_cash":246.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN [2417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-1980-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.25,"discounted_cash":121.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":242.49,"discounted_cash":242.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 10 MG PO CAPS [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0794-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 10 MG PO CAPS [2418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-0586-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DICYCLOMINE HCL 20 MG PO TABS [2420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-380-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"DIFLUPREDNATE 0.05 % OP EMUL [92859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-9240-07","type":"NDC"}],"standard_charges":[{"gross_charge":1234.77,"discounted_cash":1234.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIGOXIN 0.05 MG/ML PO SOLN [43556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0057-46","type":"NDC"}],"standard_charges":[{"gross_charge":59.82,"discounted_cash":59.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":59.82,"discounted_cash":59.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 250 MCG PO TABS [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1325-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 250 MCG PO TABS [2445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1241-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 125 MCG PO TABS [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-437-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 125 MCG PO TABS [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1324-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 125 MCG PO TABS [2444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-1240-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN [2442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3059-95","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN [2442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3059-72","type":"NDC"}],"standard_charges":[{"gross_charge":50.56,"discounted_cash":50.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN [2442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-1410-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DIGOXIN 0.1 MG/ML IJ SOLN [9853]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70515-263-10","type":"NDC"}],"standard_charges":[{"gross_charge":671.82,"discounted_cash":671.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIGOXIN 0.1 MG/ML IJ SOLN [9853]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70515-262-10","type":"NDC"}],"standard_charges":[{"gross_charge":847.96,"discounted_cash":847.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DAPSONE 25 MG PO TABS [2132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13925-504-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOBAZAM 10 MG PO TABS [112781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1305-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CLOBAZAM 10 MG PO TABS [112781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-423-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA [9630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-076-15","type":"NDC"}],"standard_charges":[{"gross_charge":90.63,"discounted_cash":90.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLINISOL SF 15 % IV SOLN [23068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0502-06","type":"NDC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":349.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN 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Pharmacy | NDC EA = 300 MG"}]},{"description":"CLARITHROMYCIN 500 MG PO TABS [9617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-226-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CLARITHROMYCIN 250 MG/5ML PO SUSR [12886]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6023-46","type":"NDC"}],"standard_charges":[{"gross_charge":858.0,"discounted_cash":858.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN 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[35627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-9292-19","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-174-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-174-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-137-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-555-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7728-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-153-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-872-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-872-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN [108132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-114-87","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CLONAZEPAM 0.5 MG PO TBDP [35627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-308-52","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG PO TBDP [35627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-308-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG PO TBDP [35627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-9292-67","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG PO TBDP [35627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-785-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 1 MG PO TABS [9638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3212-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CLONAZEPAM 0.5 MG PO TBDP [35627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-366-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"36000-008-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4777-23","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-058-20","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-058-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-317-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6900-04","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN [129194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-319-25","type":"NDC"}],"standard_charges":[{"gross_charge":69.98,"discounted_cash":69.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":139.95,"discounted_cash":139.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN [129194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.15,"discounted_cash":89.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":178.3,"discounted_cash":178.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORPROMAZINE HCL 25 MG PO TABS [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"69238-1056-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORTHALIDONE 25 MG PO TABS [1661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-317-95","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHOLESTYRAMINE 4 G PO PACK [9588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51224-011-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 G PO PACK [9588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-266-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 G PO PACK [9588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-266-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 G PO PACK [9588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-134-36","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"}]},{"description":"CHOLESTYRAMINE 4 G PO PACK [9588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-134-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 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[24559]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5823-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLORPROMAZINE HCL 25 MG PO TABS [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69238-1056-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"CHLORPROMAZINE HCL 25 MG PO TABS [1656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"Q0161","type":"HCPCS"},{"code":"68462-862-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CHLORDIAZEPOXIDE-CLIDINIUM 5-2.5 MG PO CAPS [1738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-639-11","type":"NDC"}],"standard_charges":[{"gross_charge":22.94,"discounted_cash":22.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 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[1624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-374-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CHLORDIAZEPOXIDE HCL 5 MG PO CAPS [1624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-374-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CHLORDIAZEPOXIDE HCL 25 MG PO CAPS [1623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0159-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 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[9526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"47335-330-40","type":"NDC"}],"standard_charges":[{"gross_charge":240.2,"discounted_cash":240.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CHLOROTHIAZIDE 250 MG/5ML PO SUSP [9525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-311-12","type":"NDC"}],"standard_charges":[{"gross_charge":403.85,"discounted_cash":403.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"CHLOROQUINE PHOSPHATE 250 MG PO TABS [1637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-177-50","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CHLOROPROCAINE HCL (PF) 3 % IJ SOLN [132108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"63323-478-01","type":"NDC"}],"standard_charges":[{"gross_charge":146.44,"discounted_cash":146.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CHLOROPROCAINE HCL (PF) 3 % IJ SOLN [132108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"0143-9210-01","type":"NDC"}],"standard_charges":[{"gross_charge":105.16,"discounted_cash":105.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CHLOROPROCAINE HCL (PF) 2 % IJ SOLN [132107]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"63323-477-27","type":"NDC"}],"standard_charges":[{"gross_charge":138.4,"discounted_cash":138.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 4 % EX SOLN [109392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0234-0575-04","type":"NDC"}],"standard_charges":[{"gross_charge":24.78,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-649-41","type":"NDC"}],"standard_charges":[{"gross_charge":502.56,"discounted_cash":502.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52376-021-04","type":"NDC"}],"standard_charges":[{"gross_charge":23.12,"discounted_cash":23.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN [9516]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0404-0179-03","type":"NDC"}],"standard_charges":[{"gross_charge":28.58,"discounted_cash":28.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"CHOLESTYRAMINE 4 GM/DOSE PO POWD [9589]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0940-97","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"CHOLESTYRAMINE 4 GM/DOSE PO POWD [9589]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-0536-37","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"CHOLESTYRAMINE 4 GM/DOSE PO POWD [9589]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-267-97","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-730-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-036-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-036-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-036-14","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-036-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16252-515-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-730-28","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2300-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2300-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66267-058-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-077-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-867-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-127-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN [108130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-192-82","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CIPROFLOXACIN HCL 500 MG PO TABS [25119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9928-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CINACALCET HCL 30 MG PO TABS [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64380-883-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CINACALCET HCL 30 MG PO TABS [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-440-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CILOSTAZOL 100 MG PO TABS [24474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2522-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 100 MG PO TABS [24474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0223-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 100 MG PO TABS [24474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2064-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CILOSTAZOL 100 MG PO TABS [24474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0044-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CICLESONIDE 160 MCG/ACT IN AERS [92832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70515-712-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PUFF"}]},{"description":"CHOLESTYRAMINE LIGHT 4 G PO PACK [37482]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-529-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"CINACALCET HCL 30 MG PO TABS [38100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-410-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"CIPROFLOXACIN HCL 250 MG PO TABS [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-126-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 250 MG PO TABS [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-688-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 250 MG PO TABS [25118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-411-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN [9610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69315-308-05","type":"NDC"}],"standard_charges":[{"gross_charge":82.83,"discounted_cash":82.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN [9610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-714-10","type":"NDC"}],"standard_charges":[{"gross_charge":46.23,"discounted_cash":46.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CIPROFLOXACIN HCL 0.2 MG / ML SOLUTION (STOCK A) [40890058]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-26","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN HCL 0.02 MG / ML SOLUTION (STOCK B) [40890059]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-27","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0871-16","type":"NDC"}],"standard_charges":[{"gross_charge":158.39,"discounted_cash":158.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3508-04","type":"NDC"}],"standard_charges":[{"gross_charge":90.93,"discounted_cash":90.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG PO CAPS [28843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0078-0248-61","type":"NDC"}],"standard_charges":[{"gross_charge":21.91,"discounted_cash":21.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":43.82,"discounted_cash":43.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":21.91,"discounted_cash":21.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":21.91,"discounted_cash":21.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":21.91,"discounted_cash":21.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG PO CAPS [28843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0074-3109-32","type":"NDC"}],"standard_charges":[{"gross_charge":41.72,"discounted_cash":41.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":83.43,"discounted_cash":83.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":20.86,"discounted_cash":20.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":31.29,"discounted_cash":31.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE 50 MG/ML IV SOLN [9705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0078-0109-61","type":"NDC"}],"standard_charges":[{"gross_charge":437.59,"discounted_cash":437.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE 25 MG PO CAPS [9707]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68084-879-95","type":"NDC"}],"standard_charges":[{"gross_charge":73.47,"discounted_cash":73.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":146.93,"discounted_cash":146.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.37,"discounted_cash":18.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.74,"discounted_cash":36.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":55.1,"discounted_cash":55.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE 25 MG PO CAPS [9707]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68084-879-25","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE 50 MG/ML IV SOLN [9705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0078-0109-01","type":"NDC"}],"standard_charges":[{"gross_charge":437.59,"discounted_cash":437.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-9018-19","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML PO SOLN [28844]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"0172-7313-20","type":"NDC"}],"standard_charges":[{"gross_charge":591.3,"discounted_cash":591.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG PO CAPS [28843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-9020-65","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG PO CAPS [28843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-5742-65","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN [2025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-396-03","type":"NDC"}],"standard_charges":[{"gross_charge":51.12,"discounted_cash":51.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOBENZAPRINE HCL 10 MG PO TABS [2017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-846-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-303-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70512-840-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-005-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-005-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"69680-113-99","type":"NDC"}],"standard_charges":[{"gross_charge":94.92,"discounted_cash":94.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69680-112-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68001-542-59","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-044-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-044-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-044-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-502-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"16714-302-01","type":"NDC"}],"standard_charges":[{"gross_charge":105.7,"discounted_cash":105.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN [9701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0359-05","type":"NDC"}],"standard_charges":[{"gross_charge":368.25,"discounted_cash":368.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CYCLOSPORINE 0.05 % OP EMUL [35209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-9163-30","type":"NDC"}],"standard_charges":[{"gross_charge":67.15,"discounted_cash":67.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CYCLOSPORINE 0.05 % OP EMUL [35209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-6202-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CYCLOSPORINE 25 MG PO CAPS [9707]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0078-0240-15","type":"NDC"}],"standard_charges":[{"gross_charge":106.08,"discounted_cash":106.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":212.16,"discounted_cash":212.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":26.52,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":53.04,"discounted_cash":53.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":79.56,"discounted_cash":79.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE 100 MG PO CAPS [9706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68084-921-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE 100 MG PO CAPS [9706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0078-0241-15","type":"NDC"}],"standard_charges":[{"gross_charge":88.44,"discounted_cash":88.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":176.87,"discounted_cash":176.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":88.44,"discounted_cash":88.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":88.44,"discounted_cash":88.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":88.44,"discounted_cash":88.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE 0.05 % OP EMUL [35209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-9163-60","type":"NDC"}],"standard_charges":[{"gross_charge":49.25,"discounted_cash":49.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-9018-65","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DANTROLENE SODIUM 25 MG PO CAPS [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-362-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE SODIUM 25 MG PO CAPS [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42023-124-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANTROLENE SODIUM 25 MG PO CAPS [9718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-4411-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DANAZOL 100 MG PO CAPS [9714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0555-0634-02","type":"NDC"}],"standard_charges":[{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":40.83,"discounted_cash":40.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DALBAVANCIN HCL 500 MG IV SOLR [125912]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0875","type":"HCPCS"},{"code":"57970-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":5854.66,"discounted_cash":5854.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAKINS (1/2 STRENGTH) 0.25 % EX SOLN [15950]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0436-0936-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.62,"discounted_cash":9.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"DACARBAZINE 200 MG IV SOLR [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-128-20","type":"NDC"}],"standard_charges":[{"gross_charge":113.78,"discounted_cash":113.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG IV SOLR [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-128-00","type":"NDC"}],"standard_charges":[{"gross_charge":89.18,"discounted_cash":89.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG IV SOLR [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-5075-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.34,"discounted_cash":132.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 200 MG IV SOLR [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9245-10","type":"NDC"}],"standard_charges":[{"gross_charge":84.92,"discounted_cash":84.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS [124754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-6210-30","type":"NDC"}],"standard_charges":[{"gross_charge":96.93,"discounted_cash":96.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":48.47,"discounted_cash":48.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DAPSONE 100 MG PO TABS [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-136-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 100 MG PO TABS [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49938-101-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPSONE 100 MG PO TABS [2131]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13925-505-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS [124753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-456-30","type":"NDC"}],"standard_charges":[{"gross_charge":140.92,"discounted_cash":140.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":70.46,"discounted_cash":70.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS [124753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-6205-30","type":"NDC"}],"standard_charges":[{"gross_charge":193.85,"discounted_cash":193.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":96.93,"discounted_cash":96.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS [124754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-457-30","type":"NDC"}],"standard_charges":[{"gross_charge":70.46,"discounted_cash":70.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":35.23,"discounted_cash":35.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"0517-0130-01","type":"NDC"}],"standard_charges":[{"gross_charge":435.4,"discounted_cash":435.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DACARBAZINE 200 MG IV SOLR [2091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9245-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.92,"discounted_cash":84.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DACARBAZINE 100 MG IV SOLR [2090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-127-00","type":"NDC"}],"standard_charges":[{"gross_charge":100.44,"discounted_cash":100.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYSTEINE HCL 50 MG/ML IV SOLN [2034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-1007-1","type":"NDC"}],"standard_charges":[{"gross_charge":556.6,"discounted_cash":556.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CYPROHEPTADINE HCL 4 MG PO TABS [2033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1110-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CYPROHEPTADINE HCL 4 MG PO TABS [2033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-4630-3","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYCLOSPORINE MODIFIED 25 MG PO CAPS [28842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"51862-458-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYSTEINE HCL 50 MG/ML IV SOLN [2034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-1007-3","type":"NDC"}],"standard_charges":[{"gross_charge":550.54,"discounted_cash":550.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DACARBAZINE 100 MG IV SOLR [2090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-127-10","type":"NDC"}],"standard_charges":[{"gross_charge":101.03,"discounted_cash":101.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CYTARABINE (PF) 100 MG/ML IJ SOLN [20156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-120-20","type":"NDC"}],"standard_charges":[{"gross_charge":47.68,"discounted_cash":47.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":45.48,"discounted_cash":45.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CYTARABINE (PF) 20 MG/ML IJ SOLN [96982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-305-38","type":"NDC"}],"standard_charges":[{"gross_charge":74.09,"discounted_cash":74.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":56.04,"discounted_cash":56.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS [106490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0355-56","type":"NDC"}],"standard_charges":[{"gross_charge":39.11,"discounted_cash":39.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":19.56,"discounted_cash":19.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS [106491]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0360-82","type":"NDC"}],"standard_charges":[{"gross_charge":19.56,"discounted_cash":19.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CYTARABINE (PF) SUBCUTANEOUS 20 MG/ML IJ SOLN [40840896982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-305-58","type":"NDC"}],"standard_charges":[{"gross_charge":85.16,"discounted_cash":85.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":60.47,"discounted_cash":60.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0871-99","type":"NDC"}],"standard_charges":[{"gross_charge":158.39,"discounted_cash":158.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0031-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9621-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG PO TABS [1760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4755-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG PO TABS [1760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4043-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG PO TABS [1760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0040-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG PO TABS [1759]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4754-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 3.75 MG PO TABS [1759]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-319-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-357-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLORAZEPATE DIPOTASSIUM 7.5 MG PO TABS [1760]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-158-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"CLOZAPINE 100 MG PO TABS [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-846-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 100 MG PO TABS [9647]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA [29424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-298-17","type":"NDC"}],"standard_charges":[{"gross_charge":25.75,"discounted_cash":25.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA [29424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0379-15","type":"NDC"}],"standard_charges":[{"gross_charge":60.48,"discounted_cash":60.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"CLOTRIMAZOLE 10 MG MT TROC [9644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-8146-22","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":16.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"CLOTRIMAZOLE 1 % VA CREA [1769]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61269-220-41","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"CLOTRIMAZOLE 1 % VA CREA [1769]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2003-6","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN [1768]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10135-671-81","type":"NDC"}],"standard_charges":[{"gross_charge":79.68,"discounted_cash":79.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX SOLN [1768]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1181-70","type":"NDC"}],"standard_charges":[{"gross_charge":231.51,"discounted_cash":231.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-475-47","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA [1767]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1272-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 G"}]},{"description":"CLOPIDOGREL BISULFATE 75 MG PO TABS [22142]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0253-3","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-178-30","type":"NDC"}],"standard_charges":[{"gross_charge":40.71,"discounted_cash":40.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":81.41,"discounted_cash":81.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLONIDINE 0.3 MG/24HR TD PTWK [138029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-455-04","type":"NDC"}],"standard_charges":[{"gross_charge":185.18,"discounted_cash":185.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.3 MG/24HR TD PTWK [138029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-455-01","type":"NDC"}],"standard_charges":[{"gross_charge":188.3,"discounted_cash":188.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.3 MG/24HR TD PTWK [138029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3510-54","type":"NDC"}],"standard_charges":[{"gross_charge":100.41,"discounted_cash":100.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.3 MG/24HR TD PTWK [138029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3510-04","type":"NDC"}],"standard_charges":[{"gross_charge":177.39,"discounted_cash":177.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK [138028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-024-48","type":"NDC"}],"standard_charges":[{"gross_charge":62.01,"discounted_cash":62.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK [138028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-024-11","type":"NDC"}],"standard_charges":[{"gross_charge":62.01,"discounted_cash":62.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK [138028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-454-04","type":"NDC"}],"standard_charges":[{"gross_charge":66.74,"discounted_cash":66.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK [138028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-454-01","type":"NDC"}],"standard_charges":[{"gross_charge":133.5,"discounted_cash":133.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK [138028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3509-54","type":"NDC"}],"standard_charges":[{"gross_charge":157.5,"discounted_cash":157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.2 MG/24HR TD PTWK [138028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3509-04","type":"NDC"}],"standard_charges":[{"gross_charge":129.8,"discounted_cash":129.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-023-48","type":"NDC"}],"standard_charges":[{"gross_charge":37.56,"discounted_cash":37.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-023-11","type":"NDC"}],"standard_charges":[{"gross_charge":37.56,"discounted_cash":37.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-453-04","type":"NDC"}],"standard_charges":[{"gross_charge":60.26,"discounted_cash":60.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-453-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.6,"discounted_cash":92.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE 0.1 MG/24HR TD PTWK [138027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3508-54","type":"NDC"}],"standard_charges":[{"gross_charge":93.59,"discounted_cash":93.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"CLONIDINE HCL 0.1 MG PO TABS [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2127-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE HCL 0.1 MG PO TABS [1755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-237-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-184-12","type":"NDC"}],"standard_charges":[{"gross_charge":32.68,"discounted_cash":32.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":65.36,"discounted_cash":65.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL BISULFATE 300 MG PO TABS [89346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-184-11","type":"NDC"}],"standard_charges":[{"gross_charge":40.26,"discounted_cash":40.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":80.51,"discounted_cash":80.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CLOPIDOGREL 3 MG/ML ORAL SOLUTION [40899944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999301710","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":54.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"CLOPIDOGREL 0.1 MG/ML ORAL SOLUTION [40899945]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999301610","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":54.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"CLONIDINE HCL 0.2 MG PO TABS [1756]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-238-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLONIDINE HCL 0.2 MG PO TABS [1756]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2128-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"CLOZAPINE 12.5 MG PO TBDP [88161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5416-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":294.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"COLESTIPOL HCL 1 G PO TABS [13884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0450-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"COLESTIPOL HCL 1 G PO TABS [13884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-5211-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"COLESTIPOL HCL 1 G PO TABS [13884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-0450-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"COLESEVELAM HCL 625 MG PO TABS [28372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51660-996-28","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1875 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"COLESEVELAM HCL 625 MG PO TABS [28372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"27808-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1875 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"COLCHICINE 0.6 MG PO TABS [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-727-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG PO TABS [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-187-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLCHICINE 0.6 MG PO TABS [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-187-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR [134826]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-393-06","type":"NDC"}],"standard_charges":[{"gross_charge":85.03,"discounted_cash":85.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"COLLAGENASE CLOSTRID HISTOLYT 0.9 MG IJ SOLR [101010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0775","type":"HCPCS"},{"code":"66887-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":10855.35,"discounted_cash":10855.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.58 MG"}]},{"description":"CROTALIDAE POLYVAL IMMUNE FAB IV SOLR [29313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50633-110-12","type":"NDC"}],"standard_charges":[{"gross_charge":4988.68,"discounted_cash":4988.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CROTALIDAE POLYVAL IMMUNE FAB IV SOLR [29313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50633-110-11","type":"NDC"}],"standard_charges":[{"gross_charge":10619.91,"discounted_cash":10619.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CROSS-LINKED HYALURONATE 30 MG/3ML IX PRSY [125829]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50016-95711","type":"NDC"}],"standard_charges":[{"gross_charge":3202.9,"discounted_cash":3202.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"COVID-19 MRNA VAC 6M-11Y (MODERNA) 25 MCG/0.25ML IM SUSY [154819]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"80777-291-80","type":"NDC"}],"standard_charges":[{"gross_charge":853.18,"discounted_cash":853.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"COVID-19 MRNA VAC 6M-11Y (MODERNA) 25 MCG/0.25ML IM SUSY [154819]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"80777-291-09","type":"NDC"}],"standard_charges":[{"gross_charge":853.18,"discounted_cash":853.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"COVID-19 MRNA VAC 12+ (PFIZER) 30 MCG/0.3ML IM SUSY [152430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-2432-10","type":"NDC"}],"standard_charges":[{"gross_charge":709.8,"discounted_cash":709.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"COVID-19 MRNA VAC 12+ (PFIZER) 30 MCG/0.3ML IM SUSY [152430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-2432-01","type":"NDC"}],"standard_charges":[{"gross_charge":711.88,"discounted_cash":711.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"COSYNTROPIN 0.25 MG IJ SOLR [9686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3440-71","type":"NDC"}],"standard_charges":[{"gross_charge":160.26,"discounted_cash":160.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"COPPER CU 64 DOTATATE 1 MCI/ML IV SOLN [143901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"DOTA","type":"RC"},{"code":"69945-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":4966.85,"discounted_cash":4966.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"COPPER CHLORIDE 0.4 MG/ML IV SOLN [1985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0103-4","type":"NDC"}],"standard_charges":[{"gross_charge":107.74,"discounted_cash":107.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"COPPER CHLORIDE 0.4 MG/ML IV SOLN [1985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-0103-1","type":"NDC"}],"standard_charges":[{"gross_charge":157.72,"discounted_cash":157.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"COPPER CHLORIDE 0.4 MG/ML IV SOLN [1985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4092-11","type":"NDC"}],"standard_charges":[{"gross_charge":137.13,"discounted_cash":137.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CONIVAPTAN HCL IN DEXTROSE 20-5 MG/100ML-% IV SOLN [96988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66220-160-10","type":"NDC"}],"standard_charges":[{"gross_charge":3621.4,"discounted_cash":3621.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":7232.8,"discounted_cash":7232.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"COLLODION FLEXIBLE EX LIQD [1838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"38779-0625-5","type":"NDC"}],"standard_charges":[{"gross_charge":18.4,"discounted_cash":18.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"COLLAGENASE 250 UNIT/GM EX OINT [9682]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50484-010-30","type":"NDC"}],"standard_charges":[{"gross_charge":1839.78,"discounted_cash":1839.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN [2007]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0031-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"}]},{"description":"COLCHICINE 0.6 MG PO TABS [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-899-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"CLOZAPINE 25 MG PO TABS [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-404-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG PO TABS [9648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-404-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"CLOZAPINE 25 MG PO TBDP [38479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3813-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"COLCHICINE 0.6 MG PO TABS [1821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1086-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MG"}]},{"description":"COD LIVER OIL PO CAPS [1795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"79854-600-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COBICISTAT 150 MG PO TABS [126794]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1401-1","type":"NDC"}],"standard_charges":[{"gross_charge":62.03,"discounted_cash":62.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 8 MG IV SOLR [106256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"0169-7208-01","type":"NDC"}],"standard_charges":[{"gross_charge":32479.39,"discounted_cash":32479.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 5 MG IV SOLR [92855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"0169-7205-01","type":"NDC"}],"standard_charges":[{"gross_charge":44693.16,"discounted_cash":44693.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR [92854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7189","type":"HCPCS"},{"code":"0169-7202-01","type":"NDC"}],"standard_charges":[{"gross_charge":17892.25,"discounted_cash":17892.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 500 UNITS IV KIT [132117]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58394-634-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 250 UNITS IV SOLR [19812]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7200","type":"HCPCS"},{"code":"0944-3026-02","type":"NDC"}],"standard_charges":[{"gross_charge":1678.15,"discounted_cash":1678.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV KIT [132119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58394-636-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 1000 UNITS IV KIT [132118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58394-635-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MEDIUM CHAIN TRIGLYCERIDES PO OIL [10518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41679-36513","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TB24 [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-259-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"FENOFIBRATE MICRONIZED 134 MG PO CAPS [27094]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-0522-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 134 MG"},{"gross_charge":13.92,"discounted_cash":13.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 67 MG"}]},{"description":"FENOFIBRATE 48 MG PO TABS [40009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3065-77","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 48 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENTANYL 100 MCG/HR TD PT72 [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9124-16","type":"NDC"}],"standard_charges":[{"gross_charge":164.73,"discounted_cash":164.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENOFIBRATE 145 MG PO TABS [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-458-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE 145 MG PO TABS [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-431-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FENOFIBRATE 145 MG PO TABS [40010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3066-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 145 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 MG"}]},{"description":"FELODIPINE ER 5 MG PO TB24 [27490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-234-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FENTANYL 100 MCG/HR TD PT72 [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7084-0","type":"NDC"}],"standard_charges":[{"gross_charge":24.14,"discounted_cash":24.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL 100 MCG/HR TD PT72 [27908]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7084-2","type":"NDC"}],"standard_charges":[{"gross_charge":115.96,"discounted_cash":115.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL 12 MCG/HR TD PT72 [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9112-76","type":"NDC"}],"standard_charges":[{"gross_charge":45.73,"discounted_cash":45.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":91.46,"discounted_cash":91.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"}]},{"description":"FENTANYL 50 MCG/ML FOR ANES SPINAL DOCUMENTATION [4084083037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6028-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/ML FOR ANES SPINAL DOCUMENTATION [4084083037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6025-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/ML FOR ANES SPINAL DOCUMENTATION [4084083037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-9094-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":44.11,"discounted_cash":44.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/ML FOR ANES SPINAL DOCUMENTATION [4084083037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-9093-35","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL 50 MCG/HR TD PT72 [27906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9122-98","type":"NDC"}],"standard_charges":[{"gross_charge":66.56,"discounted_cash":66.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72 [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-424-47","type":"NDC"}],"standard_charges":[{"gross_charge":26.62,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72 [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-9125-76","type":"NDC"}],"standard_charges":[{"gross_charge":23.75,"discounted_cash":23.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL 25 MCG/HR TD PT72 [27905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9121-98","type":"NDC"}],"standard_charges":[{"gross_charge":39.82,"discounted_cash":39.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL 12 MCG/HR TD PT72 [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7080-2","type":"NDC"}],"standard_charges":[{"gross_charge":97.09,"discounted_cash":97.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":194.18,"discounted_cash":194.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"}]},{"description":"FENTANYL 12 MCG/HR TD PT72 [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7080-0","type":"NDC"}],"standard_charges":[{"gross_charge":18.95,"discounted_cash":18.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":37.89,"discounted_cash":37.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"}]},{"description":"FENTANYL 12 MCG/HR TD PT72 [41382]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-423-47","type":"NDC"}],"standard_charges":[{"gross_charge":40.28,"discounted_cash":40.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"},{"gross_charge":80.56,"discounted_cash":80.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PATCH"}]},{"description":"FELODIPINE ER 5 MG PO TB24 [27490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-049-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FEBUXOSTAT 40 MG PO TABS [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-190-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FEBUXOSTAT 40 MG PO TABS [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-2244-32","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL [146517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-539-10","type":"NDC"}],"standard_charges":[{"gross_charge":244.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL [146517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-533-25","type":"NDC"}],"standard_charges":[{"gross_charge":110.5,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL [146517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-533-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.5,"discounted_cash":95.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL [146517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-531-10","type":"NDC"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":91.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL [146517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0519-14","type":"NDC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL [146518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-9540-08","type":"NDC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"FAT EMULS PLANT BASE (SAFFLOW) 50 % PO EMUL [146542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"41679-08742","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88.7 ML"}]},{"description":"FAT EMULS PLANT BASE (SAFFLOW) 50 % PO EMUL [146542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"41679-08702","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88.7 ML"}]},{"description":"FA-PYRIDOXINE-CYANOCOBALAMIN 2.5-25-2 MG PO TABS [91043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"75834-080-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FA-PYRIDOXINE-CYANOCOBALAMIN 2.5-25-2 MG PO TABS [91043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69367-224-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FAMOTIDINE PREMIXED 20-0.9 MG/50ML-% IV SOLN [30450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-5197-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"FAMOTIDINE 40 MG/5ML PO SUSR [10010]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-500-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":15.82,"discounted_cash":15.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FENTANYL 50 MCG/ML FOR ANES SPINAL DOCUMENTATION [4084083037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6028-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FEBUXOSTAT 40 MG PO TABS [97133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-028-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"FELBAMATE 600 MG PO TABS [10025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-731-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"FELODIPINE ER 2.5 MG PO TB24 [27489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367-264-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FELODIPINE ER 2.5 MG PO TB24 [27489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-233-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FELODIPINE ER 2.5 MG PO TB24 [27489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-368-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FELODIPINE ER 2.5 MG PO TB24 [27489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FELBAMATE 600 MG PO TABS [10025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72578-057-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"FENTANYL 75 MCG/HR TD PT72 [27907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-427-11","type":"NDC"}],"standard_charges":[{"gross_charge":55.6,"discounted_cash":55.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN [130449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-9094-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE-NACL 1-0.9 MG/100ML-% IV SOLN WR [408400020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63037-100-05","type":"NDC"}],"standard_charges":[{"gross_charge":379.15,"discounted_cash":379.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE-NACL 1-0.9 MG/100ML-% IV SOLN [131830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"99999-210-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE-NACL 1-0.9 MG/100ML-% IV SOLN [131830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"70092-1092-36","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE 10 MCG/ML PF PCA PREMIX [408004]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61553-791-68","type":"NDC"}],"standard_charges":[{"gross_charge":158.86,"discounted_cash":158.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE"}]},{"description":"FENTANYL CITRATE 10 MCG/ML PF PCA PREMIX [408004]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"15082-210-69","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN [139747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-806-11","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN [139747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6247-25","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN [130450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-806-13","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN [130450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-806-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE-NACL 1-0.9 MG/100ML-% IV SOLN WR [408400020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"69374-523-10","type":"NDC"}],"standard_charges":[{"gross_charge":167.2,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE-NACL 1-0.9 MG/100ML-% IV SOLN WR [408400020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"69374-523-11","type":"NDC"}],"standard_charges":[{"gross_charge":167.2,"discounted_cash":167.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FERROUS SULFATE 325 (65 FE) MG PO TABS [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0179-8054-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN [152379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0530-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"FERROUS FUMARATE-FOLIC ACID 324-1 MG PO TABS [28013]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60258-181-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FERROUS FUMARATE 325 (106 FE) MG PO TABS [3063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0813-0012-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"FERRIC SUBSULFATE N/A SOLN [3059]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59365-5006-1","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":30.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 G"}]},{"description":"FERRIC SUBSULFATE N/A SOLN [3059]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"48783-112-08","type":"NDC"}],"standard_charges":[{"gross_charge":30.25,"discounted_cash":30.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"FERRIC CITRATE 1 GM 210 MG(FE) PO TABS [126779]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59922-631-01","type":"NDC"}],"standard_charges":[{"gross_charge":46.28,"discounted_cash":46.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":92.56,"discounted_cash":92.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"},{"gross_charge":138.84,"discounted_cash":138.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"},{"gross_charge":185.12,"discounted_cash":185.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN [123023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"0517-0650-01","type":"NDC"}],"standard_charges":[{"gross_charge":3784.79,"discounted_cash":3784.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"FERRALET 90 90-1 MG PO TABS [91666]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0178-0089-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FENTANYL CITRATE-ROPIVACAINE HCL 2 MCG/ML-0.2% EPIDURAL PREMIX WRAPPER [4081001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-9999-49","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE-ROPIVACAINE HCL 2 MCG/ML-0.2% EPIDURAL PREMIX WRAPPER [4081001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-7108-36","type":"NDC"}],"standard_charges":[{"gross_charge":218.8,"discounted_cash":218.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE-ROPIVACAINE HCL 2 MCG/ML-0.2% EPIDURAL PREMIX WRAPPER [4081001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42852-215-10","type":"NDC"}],"standard_charges":[{"gross_charge":188.16,"discounted_cash":188.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN [130450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"17478-030-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN [130451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-806-20","type":"NDC"}],"standard_charges":[{"gross_charge":55.36,"discounted_cash":55.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":55.36,"discounted_cash":55.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":55.36,"discounted_cash":55.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN [130451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-806-14","type":"NDC"}],"standard_charges":[{"gross_charge":46.83,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":46.83,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":46.83,"discounted_cash":46.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN [130451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6029-25","type":"NDC"}],"standard_charges":[{"gross_charge":90.76,"discounted_cash":90.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":90.76,"discounted_cash":90.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":90.76,"discounted_cash":90.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN [130451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6029-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.52,"discounted_cash":66.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":66.52,"discounted_cash":66.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":66.52,"discounted_cash":66.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML NA SOLN [125720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6024-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN [130450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-9094-18","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FERROUS SULFATE 325 (65 FE) MG PO TABS [3074]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-703-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"}]},{"description":"FAMOTIDINE 40 MG PO TABS [10012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5729-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESTROGENS CONJUGATED 1.25 MG PO TABS [2938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-1104-81","type":"NDC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.45 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.625 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ESTROGENS CONJUGATED 0.625 MG/GM VA CREA [148855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-0872-21","type":"NDC"}],"standard_charges":[{"gross_charge":2724.84,"discounted_cash":2724.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"ESTROGENS CONJUGATED 25 MG IJ SOLR [9972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0046-0749-05","type":"NDC"}],"standard_charges":[{"gross_charge":2253.45,"discounted_cash":2253.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"ESTROGENS CONJUGATED 0.625 MG PO TABS [9974]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-1102-81","type":"NDC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.45 MG"},{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.625 MG"},{"gross_charge":83.63,"discounted_cash":83.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"},{"gross_charge":83.63,"discounted_cash":83.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ESTROGENS CONJUGATED 0.45 MG PO TABS [36198]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-1101-81","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.45 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.625 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ESZOPICLONE 1 MG PO TABS [40320]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-629-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESZOPICLONE 2 MG PO TABS [40321]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-619-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ETHAMBUTOL HCL 400 MG PO TABS [9983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ETHAMBUTOL HCL 100 MG PO TABS [9982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-280-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ETHACRYNIC ACID 25 MG PO TABS [9980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-405-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETHACRYNIC ACID 25 MG PO TABS [9980]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1690-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETHACRYNATE SODIUM 50 MG IV SOLR [9979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-297-50","type":"NDC"}],"standard_charges":[{"gross_charge":3043.43,"discounted_cash":3043.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ETANERCEPT 50 MG/ML SC SOAJ [125719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58406-445-01","type":"NDC"}],"standard_charges":[{"gross_charge":2024.49,"discounted_cash":2024.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4048.97,"discounted_cash":4048.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ESZOPICLONE 3 MG PO TABS [40322]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-617-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"ESTROGENS CONJUGATED 0.3 MG PO TABS [9973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0046-1100-81","type":"NDC"}],"standard_charges":[{"gross_charge":41.82,"discounted_cash":41.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":83.63,"discounted_cash":83.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.45 MG"},{"gross_charge":125.45,"discounted_cash":125.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.625 MG"},{"gross_charge":125.45,"discounted_cash":125.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"},{"gross_charge":209.07,"discounted_cash":209.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-8770-35","type":"NDC"}],"standard_charges":[{"gross_charge":934.07,"discounted_cash":934.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"ESTRADIOL 0.1 MG/24HR TD PTWK [28409]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3352-99","type":"NDC"}],"standard_charges":[{"gross_charge":92.39,"discounted_cash":92.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.1 MG/24HR TD PTWK [28409]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3352-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24HR TD PTWK [28408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3350-99","type":"NDC"}],"standard_charges":[{"gross_charge":96.13,"discounted_cash":96.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24HR TD PTWK [28408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3350-16","type":"NDC"}],"standard_charges":[{"gross_charge":66.96,"discounted_cash":66.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.05 MG/24HR TD PTTW [27459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4642-16","type":"NDC"}],"standard_charges":[{"gross_charge":48.24,"discounted_cash":48.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.025 MG/24HR TD PTWK [27462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3349-99","type":"NDC"}],"standard_charges":[{"gross_charge":100.77,"discounted_cash":100.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL 0.025 MG/24HR TD PTWK [27462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3349-16","type":"NDC"}],"standard_charges":[{"gross_charge":84.48,"discounted_cash":84.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTAZOLAM 1 MG PO TABS [9961]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0744-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"EST ESTROGENS-METHYLTEST 0.625-1.25 MG PO TABS [9959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-150-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"EST ESTROGENS-METHYLTEST 0.625-1.25 MG PO TABS [9959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657-406-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA [9969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-097-35","type":"NDC"}],"standard_charges":[{"gross_charge":94.86,"discounted_cash":94.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 G"}]},{"description":"ETHAMBUTOL HCL 400 MG PO TABS [9983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68850-012-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ESTRADIOL 1 MG PO TABS [9967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-333-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ESTRADIOL-NORETHINDRONE ACET 0.05-0.14 MG/DAY TD PTTW [27464]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68968-0514-1","type":"NDC"}],"standard_charges":[{"gross_charge":84.08,"discounted_cash":84.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"ESTRADIOL VALERATE 40 MG/ML IM OIL [2932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023-112-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.7,"discounted_cash":95.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":191.39,"discounted_cash":191.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":382.77,"discounted_cash":382.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESTRADIOL VALERATE 20 MG/ML IM OIL [2931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":114.32,"discounted_cash":114.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":228.64,"discounted_cash":228.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":457.27,"discounted_cash":457.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESTRADIOL VALERATE 20 MG/ML IM OIL [2931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0420-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.66,"discounted_cash":75.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":151.31,"discounted_cash":151.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":302.62,"discounted_cash":302.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"ESTRADIOL CYPIONATE 5 MG/ML IM OIL [2929]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0271-01","type":"NDC"}],"standard_charges":[{"gross_charge":288.85,"discounted_cash":288.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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[10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-397-08","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG PO TABS [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-595-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG PO TABS [10011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7193-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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[408125093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-739-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMCICLOVIR 250 MG PO TABS [16081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"33342-025-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FAMOTIDINE 20 MG/2 ML IV SOLN WR [408125093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-739-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 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[408125093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-751-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG/2 ML IV SOLN WR [408125093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70860-751-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FAMOTIDINE 20 MG/2 ML IV SOLN WR [408125093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-739-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 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[108431]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219-1722-6","type":"NDC"}],"standard_charges":[{"gross_charge":126.86,"discounted_cash":126.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ETOPOSIDE 50 MG PO CAPS [10001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0378-3266-94","type":"NDC"}],"standard_charges":[{"gross_charge":328.5,"discounted_cash":328.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN [125055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"68001-265-25","type":"NDC"}],"standard_charges":[{"gross_charge":87.77,"discounted_cash":87.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN [125055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"68001-265-22","type":"NDC"}],"standard_charges":[{"gross_charge":85.91,"discounted_cash":85.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN [125055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323-104-05","type":"NDC"}],"standard_charges":[{"gross_charge":75.32,"discounted_cash":75.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN [125055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.32,"discounted_cash":75.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN [123603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"68001-265-27","type":"NDC"}],"standard_charges":[{"gross_charge":481.1,"discounted_cash":481.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN [123603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"68001-265-24","type":"NDC"}],"standard_charges":[{"gross_charge":361.1,"discounted_cash":361.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-447-20","type":"NDC"}],"standard_charges":[{"gross_charge":47.32,"discounted_cash":47.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN [20472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-674-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ETODOLAC ER 500 MG PO TB24 [28746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4052-4","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ETHYL CHLORIDE EX AERO [2951]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0386-0001-02","type":"NDC"}],"standard_charges":[{"gross_charge":340.31,"discounted_cash":340.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"ETHIODIZED OIL 480 MG/ML IJ OIL [146526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67684-1901-2","type":"NDC"}],"standard_charges":[{"gross_charge":5387.84,"discounted_cash":5387.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EUCERIN ORIGINAL HEALING EX LOTN [113667]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-4299-09","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 236 ML"}]},{"description":"EUCERIN ORIGINAL HEALING EX LOTN [113667]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72140-00023","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"EUFLEXXA 20 MG/2ML IX SOSY FOR AMB USE [408126648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55566-4100-1","type":"NDC"}],"standard_charges":[{"gross_charge":716.15,"discounted_cash":716.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"EZETIMIBE 10 MG PO TABS [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59651-052-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EZETIMIBE 10 MG PO TABS [34153]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-433-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"EXENATIDE 10 MCG/0.04ML SC SOPN [105629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-6524-01","type":"NDC"}],"standard_charges":[{"gross_charge":4953.84,"discounted_cash":4953.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 ML"}]},{"description":"EXEMESTANE 25 MG PO TABS [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-316-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.15,"discounted_cash":21.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.29,"discounted_cash":42.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG PO TABS [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-2858-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.03,"discounted_cash":24.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":48.06,"discounted_cash":48.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG PO TABS [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-108-30","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":39.84,"discounted_cash":39.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG PO TABS [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0595-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EXEMESTANE 25 MG PO TABS [26551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0080-13","type":"NDC"}],"standard_charges":[{"gross_charge":65.61,"discounted_cash":65.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":131.22,"discounted_cash":131.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EVEROLIMUS 0.5 MG PO TABS [104877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"51991-380-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EVEROLIMUS 0.5 MG PO TABS [104877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-0471-21","type":"NDC"}],"standard_charges":[{"gross_charge":85.78,"discounted_cash":85.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EUCERIN ORIGINAL HEALING EX LOTN [113667]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72140-11019","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63304-735-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN [95693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39328-057-50","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG OF IRON"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 27 MG OF IRON"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG OF IRON"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG OF IRON"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG OF IRON"}]},{"description":"FLUPHENAZINE HCL 1 MG PO TABS [3218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1678-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN [3215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-359-59","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":61.03,"discounted_cash":61.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":122.05,"discounted_cash":122.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN [3215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9529-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.24,"discounted_cash":54.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":108.48,"discounted_cash":108.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":216.96,"discounted_cash":216.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-9989-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-845-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.93,"discounted_cash":18.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.86,"discounted_cash":37.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUPHENAZINE HCL 2.5 MG/ML IJ SOLN [3216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-281-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":58.91,"discounted_cash":58.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FLUPHENAZINE HCL 5 MG PO TABS [3221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1790-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-195-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-700-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3270-99","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE (INHAL) 50 MCG/ACT IN AEPB [149346]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0600-02","type":"NDC"}],"standard_charges":[{"gross_charge":856.08,"discounted_cash":856.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE FUROATE-VILANTEROL 200-25 MCG/ACT IN AEPB [149303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0882-14","type":"NDC"}],"standard_charges":[{"gross_charge":593.72,"discounted_cash":593.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FLUTICASONE FUROATE-VILANTEROL 200-25 MCG/ACT IN AEPB [149303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0882-10","type":"NDC"}],"standard_charges":[{"gross_charge":2503.8,"discounted_cash":2503.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE FUROATE-VILANTEROL 100-25 MCG/ACT IN AEPB [149300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0859-14","type":"NDC"}],"standard_charges":[{"gross_charge":593.72,"discounted_cash":593.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FLUTICASONE FUROATE-VILANTEROL 100-25 MCG/ACT IN AEPB [149300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0859-10","type":"NDC"}],"standard_charges":[{"gross_charge":1938.39,"discounted_cash":1938.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE FUROATE 200 MCG/ACT IN AEPB [127201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0876-14","type":"NDC"}],"standard_charges":[{"gross_charge":549.95,"discounted_cash":549.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 EACH"}]},{"description":"FLUTICASONE FUROATE 100 MCG/ACT IN AEPB [127200]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0874-14","type":"NDC"}],"standard_charges":[{"gross_charge":410.85,"discounted_cash":410.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 EACH"}]},{"description":"FLURBIPROFEN SODIUM 0.03 % OP SOLN [10080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69292-722-25","type":"NDC"}],"standard_charges":[{"gross_charge":201.08,"discounted_cash":201.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FLURAZEPAM HCL 15 MG PO CAPS [3223]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4415-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-845-40","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.93,"discounted_cash":18.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.86,"discounted_cash":37.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-244-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.74,"discounted_cash":19.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":39.48,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUORESCEIN SODIUM 10 % IV SOLN [135423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-253-10","type":"NDC"}],"standard_charges":[{"gross_charge":176.97,"discounted_cash":176.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":442.42,"discounted_cash":442.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUORESCEIN SODIUM 10 % IV SOLN [135423]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0092-65","type":"NDC"}],"standard_charges":[{"gross_charge":140.17,"discounted_cash":140.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":350.41,"discounted_cash":350.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"83851-100-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"83851-100-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51801-009-40","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17238-900-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"FLUORESCEIN SODIUM 1 MG OP STRP [27663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17238-900-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"FLUORESCEIN SODIUM 0.6 MG OP STRP [27662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-403-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 STRIP"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA [3187]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1386-2","type":"NDC"}],"standard_charges":[{"gross_charge":95.58,"discounted_cash":95.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA [3187]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1253-2","type":"NDC"}],"standard_charges":[{"gross_charge":165.24,"discounted_cash":165.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA [3187]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0262-30","type":"NDC"}],"standard_charges":[{"gross_charge":84.6,"discounted_cash":84.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"FLUNISOLIDE 25 MCG/ACT (0.025%) NA SOLN [32375]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-344-25","type":"NDC"}],"standard_charges":[{"gross_charge":327.6,"discounted_cash":327.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"36000-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-264-15","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUOROMETHOLONE 0.1 % OP OINT [19721]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-0316-04","type":"NDC"}],"standard_charges":[{"gross_charge":807.54,"discounted_cash":807.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"FLUOROURACIL 50MG/ML SYRINGE (FOR INTRALESIONAL USE) [40882204]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-117-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.46,"discounted_cash":44.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4721-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":23.67,"discounted_cash":23.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":47.34,"discounted_cash":47.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0721-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":14.28,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE HCL 20 MG PO CAPS [10070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-193-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOXETINE HCL 10 MG PO CAPS [10069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-647-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FLUOROURACIL 50MG/ML SYRINGE (FOR INTRALESIONAL USE) [40882204]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-117-18","type":"NDC"}],"standard_charges":[{"gross_charge":42.47,"discounted_cash":42.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"FLUOROMETHOLONE 0.1 % OP SUSP [3208]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-880-05","type":"NDC"}],"standard_charges":[{"gross_charge":432.51,"discounted_cash":432.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP [70536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0829-1","type":"NDC"}],"standard_charges":[{"gross_charge":6.1,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 G"}]},{"description":"FLUTICASONE PROPIONATE HFA 110 MCG/ACT IN AERO [40698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0719-20","type":"NDC"}],"standard_charges":[{"gross_charge":1477.44,"discounted_cash":1477.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"FLUTICASONE PROPIONATE HFA 110 MCG/ACT IN AERO [40698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-079-96","type":"NDC"}],"standard_charges":[{"gross_charge":994.11,"discounted_cash":994.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"FOSINOPRIL SODIUM 20 MG PO TABS [10095]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-387-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FOSINOPRIL SODIUM 10 MG PO TABS [10094]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-386-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G PO PACK [14825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70700-268-99","type":"NDC"}],"standard_charges":[{"gross_charge":423.92,"discounted_cash":423.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G PO PACK [14825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70700-268-94","type":"NDC"}],"standard_charges":[{"gross_charge":295.71,"discounted_cash":295.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G PO PACK [14825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-4300-01","type":"NDC"}],"standard_charges":[{"gross_charge":420.06,"discounted_cash":420.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"FOSCARNET SODIUM 6000 MG/250ML IV SOLN [130436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76310-024-25","type":"NDC"}],"standard_charges":[{"gross_charge":2843.5,"discounted_cash":2843.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"72205-054-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.46,"discounted_cash":89.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"70860-783-10","type":"NDC"}],"standard_charges":[{"gross_charge":132.48,"discounted_cash":132.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR [106783]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1453","type":"HCPCS"},{"code":"68001-523-36","type":"NDC"}],"standard_charges":[{"gross_charge":132.48,"discounted_cash":132.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"FORMALDEHYDE 10 % EX SOLN [3244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51552-427-09","type":"NDC"}],"standard_charges":[{"gross_charge":199.05,"discounted_cash":199.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3800 ML"}]},{"description":"FORMALDEHYDE 10 % EX SOLN [3244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51552-427-06","type":"NDC"}],"standard_charges":[{"gross_charge":217.6,"discounted_cash":217.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-232-10","type":"NDC"}],"standard_charges":[{"gross_charge":92.41,"discounted_cash":92.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN [108028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-232-00","type":"NDC"}],"standard_charges":[{"gross_charge":180.83,"discounted_cash":180.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-231-10","type":"NDC"}],"standard_charges":[{"gross_charge":111.75,"discounted_cash":111.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FOSINOPRIL SODIUM 20 MG PO TABS [10095]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-857-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY [149049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"0310-0720-10","type":"NDC"}],"standard_charges":[{"gross_charge":5823.01,"discounted_cash":5823.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":11646.02,"discounted_cash":11646.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FREMANEZUMAB-VFRM 225 MG/1.5ML SC SOSY [138108]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51759-204-10","type":"NDC"}],"standard_charges":[{"gross_charge":3904.42,"discounted_cash":3904.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":11713.25,"discounted_cash":11713.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 675 MG"}]},{"description":"FREMANEZUMAB-VFRM 225 MG/1.5ML SC SOAJ [142343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51759-202-22","type":"NDC"}],"standard_charges":[{"gross_charge":4199.38,"discounted_cash":4199.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12598.12,"discounted_cash":12598.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 675 MG"}]},{"description":"FREMANEZUMAB-VFRM 225 MG/1.5ML SC SOAJ [142343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51759-202-11","type":"NDC"}],"standard_charges":[{"gross_charge":3999.75,"discounted_cash":3999.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":11999.25,"discounted_cash":11999.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 675 MG"}]},{"description":"FREMANEZUMAB-VFRM 225 MG/1.5ML SC SOAJ [142343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51759-202-10","type":"NDC"}],"standard_charges":[{"gross_charge":3999.75,"discounted_cash":3999.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":11999.25,"discounted_cash":11999.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 675 MG"}]},{"description":"FOSTEMSAVIR TROMETHAMINE ER 600 MG PO TB12 [143476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-250-18","type":"NDC"}],"standard_charges":[{"gross_charge":914.55,"discounted_cash":914.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68462-621-54","type":"NDC"}],"standard_charges":[{"gross_charge":49.65,"discounted_cash":49.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG PE"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68462-621-02","type":"NDC"}],"standard_charges":[{"gross_charge":49.65,"discounted_cash":49.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG PE"}]},{"description":"FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN [88011]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64679-729-02","type":"NDC"}],"standard_charges":[{"gross_charge":55.21,"discounted_cash":55.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG PE"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-252-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN [108027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-231-00","type":"NDC"}],"standard_charges":[{"gross_charge":188.64,"discounted_cash":188.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55111-678-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.66,"discounted_cash":52.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FLUVOXAMINE MALEATE 50 MG PO TABS [10085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1671-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"FLUTICASONE-UMECLIDIN-VILANT 200-62.5-25 MCG/ACT IN AEPB [149315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0893-14","type":"NDC"}],"standard_charges":[{"gross_charge":1031.36,"discounted_cash":1031.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FLUTICASONE-UMECLIDIN-VILANT 200-62.5-25 MCG/ACT IN AEPB [149315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0893-10","type":"NDC"}],"standard_charges":[{"gross_charge":3484.8,"discounted_cash":3484.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE-UMECLIDIN-VILANT 100-62.5-25 MCG/ACT IN AEPB [149311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0887-14","type":"NDC"}],"standard_charges":[{"gross_charge":1031.36,"discounted_cash":1031.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"FLUTICASONE-UMECLIDIN-VILANT 100-62.5-25 MCG/ACT IN AEPB [149311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0887-10","type":"NDC"}],"standard_charges":[{"gross_charge":3385.08,"discounted_cash":3385.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE-SALMETEROL 250-50 MCG/ACT IN AEPB [147942]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0327-56","type":"NDC"}],"standard_charges":[{"gross_charge":735.0,"discounted_cash":735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"FLUTICASONE PROPIONATE HFA 44 MCG/ACT IN AERO [40697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-078-96","type":"NDC"}],"standard_charges":[{"gross_charge":742.53,"discounted_cash":742.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.6 G"}]},{"description":"FLUTICASONE PROPIONATE HFA 44 MCG/ACT IN AERO [40697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0718-20","type":"NDC"}],"standard_charges":[{"gross_charge":1103.59,"discounted_cash":1103.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.6 G"}]},{"description":"FLUTICASONE PROPIONATE HFA 220 MCG/ACT IN AERO [40699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-080-96","type":"NDC"}],"standard_charges":[{"gross_charge":1544.12,"discounted_cash":1544.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"FLUTICASONE PROPIONATE HFA 220 MCG/ACT IN AERO [40699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0720-20","type":"NDC"}],"standard_charges":[{"gross_charge":2294.86,"discounted_cash":2294.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 G"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55111-678-11","type":"NDC"}],"standard_charges":[{"gross_charge":57.23,"discounted_cash":57.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FLUVOXAMINE MALEATE 50 MG PO TABS [10085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN [32215]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3443-95","type":"NDC"}],"standard_charges":[{"gross_charge":74.08,"discounted_cash":74.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN [108029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150-233-10","type":"NDC"}],"standard_charges":[{"gross_charge":93.57,"discounted_cash":93.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN [108029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111-681-10","type":"NDC"}],"standard_charges":[{"gross_charge":127.41,"discounted_cash":127.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN [3232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-184-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN [3232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-1100-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG PO TABS [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-127-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG PO TABS [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11788-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG PO TABS [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534-165-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FOLIC ACID 1 MG PO TABS [3233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534-165-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0997-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"FLEET PEDIATRIC 3.5-9.5 GM/59ML RE ENEM [3128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0132-0202-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 66 ML"}]},{"description":"FLECAINIDE ACETATE 100 MG PO TABS [10041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"FLAVOXATE HCL 100 MG PO TABS [10039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50268-324-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FLOTUFOLASTAT F 18 GALLIUM 296-5846 MBQ/ML IV SOLN [151509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"#NAME?","type":"RC"},{"code":"A9608","type":"HCPCS"},{"code":"69932-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":6515.04,"discounted_cash":6515.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"FLAVOXATE HCL 100 MG PO TABS [10039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0574-0115-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FINASTERIDE 5 MG PO TABS [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-314-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FINASTERIDE 5 MG PO TABS [10037]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-314-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY [129173]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314-318-05","type":"NDC"}],"standard_charges":[{"gross_charge":1742.38,"discounted_cash":1742.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"}]},{"description":"FILGRASTIM-AAFI 480 MCG/1.6ML IJ SOLN [139113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"0069-0294-01","type":"NDC"}],"standard_charges":[{"gross_charge":1599.32,"discounted_cash":1599.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.6 ML"}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY [138034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"0069-0292-10","type":"NDC"}],"standard_charges":[{"gross_charge":1596.11,"discounted_cash":1596.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"}]},{"description":"FLUCICLOVINE F 18 9-221 MCI/ML IV SOLN [138720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"#NAME?","type":"RC"},{"code":"A9588","type":"HCPCS"},{"code":"69932-001-30","type":"NDC"}],"standard_charges":[{"gross_charge":10780.16,"discounted_cash":10780.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-3420-41","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5411-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-5411-46","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FILGRASTIM-AAFI 480 MCG/0.8ML IJ SOSY [138034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"0069-0292-01","type":"NDC"}],"standard_charges":[{"gross_charge":1604.26,"discounted_cash":1604.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 480 MCG"}]},{"description":"FILGRASTIM-AAFI 300 MCG/0.5ML IJ SOSY [138033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5110","type":"HCPCS"},{"code":"0069-0291-10","type":"NDC"}],"standard_charges":[{"gross_charge":1006.94,"discounted_cash":1006.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MCG"}]},{"description":"FIDAXOMICIN 200 MG PO TABS [110360]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52015-080-01","type":"NDC"}],"standard_charges":[{"gross_charge":754.02,"discounted_cash":754.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FEXOFENADINE-PSEUDOEPHED ER 60-120 MG PO TB12 [27522]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167-4310-6","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-462-75","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-462-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-462-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FESOTERODINE FUMARATE ER 4 MG PO TB24 [96973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-0242-30","type":"NDC"}],"standard_charges":[{"gross_charge":57.15,"discounted_cash":57.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":114.29,"discounted_cash":114.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"FERUMOXYTOL 510 MG/17ML IV SOLN [98312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"59338-775-01","type":"NDC"}],"standard_charges":[{"gross_charge":4035.24,"discounted_cash":4035.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"FERUMOXYTOL 510 MG/17ML IV SOLN [98312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"0781-3154-01","type":"NDC"}],"standard_charges":[{"gross_charge":2115.68,"discounted_cash":2115.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48985-00170","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49035-995-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FEXOFENADINE-PSEUDOEPHED ER 60-120 MG PO TB12 [27522]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167-4310-4","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"FEXOFENADINE HCL 60 MG PO TABS [21529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-425-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-43022","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-43021","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FEXOFENADINE HCL 180 MG PO TABS [25425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49035-995-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6500-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4321-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN [10049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69784-002-06","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN [10049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4688-22","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN [10049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4688-18","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN [10049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-6046-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"FLUCONAZOLE 40 MG/ML PO SUSR [14233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-150-35","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":19.44,"discounted_cash":19.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-102-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-728-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4321-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4688-12","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70655-088-06","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUDEOXYGLUCOSE F 18 20-200 MCI/ML IV SOLN [153762]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"#NAME?","type":"RC"},{"code":"40028-511-30","type":"NDC"}],"standard_charges":[{"gross_charge":232.82,"discounted_cash":232.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"FLUCYTOSINE 500 MG PO CAPS [10052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-332-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.85,"discounted_cash":158.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":79.43,"discounted_cash":79.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 50 MG/ML PO SUSP [4082010052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-0427-27","type":"NDC"}],"standard_charges":[{"gross_charge":143.78,"discounted_cash":143.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":71.89,"discounted_cash":71.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 50 MG/ML PO SUSP [4082010052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-0427-26","type":"NDC"}],"standard_charges":[{"gross_charge":143.78,"discounted_cash":143.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":71.89,"discounted_cash":71.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 50 MG/ML PO SUSP [4082010052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-0427-25","type":"NDC"}],"standard_charges":[{"gross_charge":246.48,"discounted_cash":246.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":123.24,"discounted_cash":123.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 250 MG PO CAPS [10051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-331-01","type":"NDC"}],"standard_charges":[{"gross_charge":164.24,"discounted_cash":164.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":82.12,"discounted_cash":82.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCYTOSINE 250 MG PO CAPS [10051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0427-25","type":"NDC"}],"standard_charges":[{"gross_charge":269.31,"discounted_cash":269.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":134.66,"discounted_cash":134.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69784-003-06","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5016-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-691-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67405-602-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-728-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"FLUCONAZOLE 100 MG PO TABS [10044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-252-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR [29746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-2351-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"DOXEPIN HCL 10 MG PO CAPS [2608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1166-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN HCL 10 MG PO CAPS [2608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-217-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN HCL 10 MG/ML PO CONC [2614]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-512-40","type":"NDC"}],"standard_charges":[{"gross_charge":193.68,"discounted_cash":193.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"DOXEPIN HCL 10 MG PO CAPS [2608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-167-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXAZOSIN MESYLATE 2 MG PO TABS [9895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-784-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXEPIN HCL 25 MG PO CAPS [2611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1170-9","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN HCL 50 MG PO CAPS [2612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-438-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN HCL 50 MG PO CAPS [2612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-438-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXEPIN HCL 50 MG PO CAPS [2612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7054-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"DOXAZOSIN MESYLATE 2 MG PO TABS [9895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-414-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL PF 22.3-6.8 MG/ML OP SOLN (IP SOLID MIX) [4082022982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-946-01","type":"NDC"}],"standard_charges":[{"gross_charge":118.26,"discounted_cash":118.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL PF 22.3-6.8 MG/ML OP SOLN (IP SOLID MIX) [4082022982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-030-02","type":"NDC"}],"standard_charges":[{"gross_charge":96.66,"discounted_cash":96.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"82584-605-10","type":"NDC"}],"standard_charges":[{"gross_charge":1432.38,"discounted_cash":1432.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.78,"discounted_cash":48.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN [22982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-147-26","type":"NDC"}],"standard_charges":[{"gross_charge":195.96,"discounted_cash":195.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN [14471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-141-26","type":"NDC"}],"standard_charges":[{"gross_charge":201.0,"discounted_cash":201.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DORNASE ALFA 2.5 MG/2.5ML IN SOLN [12211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50242-100-39","type":"NDC"}],"standard_charges":[{"gross_charge":120.23,"discounted_cash":120.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"DORAVIRINE 100 MG PO TABS [138042]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-3069-01","type":"NDC"}],"standard_charges":[{"gross_charge":381.93,"discounted_cash":381.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"9999-1007-02","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-7809-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-7809-22","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0409-7809-11","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0338-1007-03","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN [14845]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0338-1007-02","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOXAPRAM HCL 20 MG/ML IV SOLN [2607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6018-01","type":"NDC"}],"standard_charges":[{"gross_charge":336.64,"discounted_cash":336.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOXAZOSIN MESYLATE 1 MG PO TABS [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4021-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN MESYLATE 2 MG PO TABS [9895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-2512-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.47,"discounted_cash":18.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":36.93,"discounted_cash":36.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":73.86,"discounted_cash":73.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":147.72,"discounted_cash":147.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN MESYLATE 1 MG PO TABS [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0093-0","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXAZOSIN MESYLATE 1 MG PO TABS [9894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-211-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"DOXERCALCIFEROL 0.5 MCG PO CAPS [38830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-538-25","type":"NDC"}],"standard_charges":[{"gross_charge":35.19,"discounted_cash":35.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"},{"gross_charge":70.37,"discounted_cash":70.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":175.92,"discounted_cash":175.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MCG"}]},{"description":"DROXIDOPA 100 MG PO CAPS [126078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-072-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"DROXIDOPA 100 MG PO CAPS [126078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-704-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"DROXIDOPA 100 MG PO CAPS [126078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-014-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN [2654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-9702-25","type":"NDC"}],"standard_charges":[{"gross_charge":74.78,"discounted_cash":74.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN [2654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.62,"discounted_cash":67.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DTAP-IPV VACCINE 0.5 ML IM SUSY [146540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-812-52","type":"NDC"}],"standard_charges":[{"gross_charge":320.97,"discounted_cash":320.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DTAP-HEPATITIS B RECOMB-IPV IM SUSY [147740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-811-52","type":"NDC"}],"standard_charges":[{"gross_charge":428.62,"discounted_cash":428.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DTAP-HEPATITIS B RECOMB-IPV IM SUSY [147740]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-811-43","type":"NDC"}],"standard_charges":[{"gross_charge":400.18,"discounted_cash":400.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DROXIDOPA 200 MG PO CAPS [126079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-104-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 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NDC EA = 10 MG"},{"gross_charge":18.32,"discounted_cash":18.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":36.64,"discounted_cash":36.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DOXYLAMINE-PYRIDOXINE 10-10 MG PO TBEC [121532]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70505-100-10","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"DOXYLAMINE-PYRIDOXINE 10-10 MG PO TBEC 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[2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-312-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG PO TABS [2625]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-2112-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"68382-910-10","type":"NDC"}],"standard_charges":[{"gross_charge":132.96,"discounted_cash":132.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"68382-910-01","type":"NDC"}],"standard_charges":[{"gross_charge":114.66,"discounted_cash":114.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"67457-437-00","type":"NDC"}],"standard_charges":[{"gross_charge":125.56,"discounted_cash":125.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"63323-130-41","type":"NDC"}],"standard_charges":[{"gross_charge":123.68,"discounted_cash":123.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"63323-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":90.64,"discounted_cash":90.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1271","type":"HCPCS"},{"code":"63323-130-02","type":"NDC"}],"standard_charges":[{"gross_charge":124.85,"discounted_cash":124.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"DOXYCYCLINE 40 MG PO CPDR [76670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0299-3822-30","type":"NDC"}],"standard_charges":[{"gross_charge":173.49,"discounted_cash":173.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP [155025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68001-629-36","type":"NDC"}],"standard_charges":[{"gross_charge":1359.32,"discounted_cash":1359.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DRONEDARONE HCL 400 MG PO TABS [98329]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-4142-60","type":"NDC"}],"standard_charges":[{"gross_charge":78.23,"discounted_cash":78.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"DRONABINOL 2.5 MG PO CAPS [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-867-06","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 5 MG PO CAPS [9905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6746-04","type":"NDC"}],"standard_charges":[{"gross_charge":92.92,"discounted_cash":92.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":23.23,"discounted_cash":23.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":46.46,"discounted_cash":46.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 2.5 MG PO CAPS [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-753-60","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 2.5 MG PO CAPS [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-375-21","type":"NDC"}],"standard_charges":[{"gross_charge":104.33,"discounted_cash":104.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":26.09,"discounted_cash":26.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":52.17,"discounted_cash":52.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DRONABINOL 2.5 MG PO CAPS [9904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-375-11","type":"NDC"}],"standard_charges":[{"gross_charge":92.38,"discounted_cash":92.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":23.1,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":46.19,"discounted_cash":46.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross 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[2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-5820-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.98,"discounted_cash":44.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-415-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-106-00","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-767-08","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-767-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-415-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 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[18315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2347-31","type":"NDC"}],"standard_charges":[{"gross_charge":868.0,"discounted_cash":868.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN [18315]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-1075-02","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"DOBUTAMINE HCL 250 MG/20ML IV SOLN [77318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70436-203-82","type":"NDC"}],"standard_charges":[{"gross_charge":56.32,"discounted_cash":56.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOBUTAMINE HCL 250 MG/20ML IV SOLN [77318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2344-68","type":"NDC"}],"standard_charges":[{"gross_charge":56.01,"discounted_cash":56.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOBUTAMINE HCL 250 MG/20ML IV SOLN [77318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2344-62","type":"NDC"}],"standard_charges":[{"gross_charge":56.92,"discounted_cash":56.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOBUTAMINE HCL 250 MG/20ML IV SOLN [77318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2344-02","type":"NDC"}],"standard_charges":[{"gross_charge":63.64,"discounted_cash":63.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOBUTAMINE HCL 250 MG/20ML IV SOLN [77318]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2344-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.68,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DM-GUAIFENESIN ER 30-600 MG PO TB12 [27543]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-05012","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6364-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TB24 [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-310-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TB24 [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-594-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TB24 [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-766-08","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 250 MG PO TB24 [34418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-766-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DOCETAXEL 20 MG/ML IV CONC [106443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"0955-1020-01","type":"NDC"}],"standard_charges":[{"gross_charge":688.51,"discounted_cash":688.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-7126-13","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6364-45","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"090446-736","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DIVALPROEX SODIUM ER 500 MG PO TB24 [81426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0473-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"DOCETAXEL 20 MG/ML IV CONC [106443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729-267-63","type":"NDC"}],"standard_charges":[{"gross_charge":205.4,"discounted_cash":205.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOCETAXEL 20 MG/ML IV CONC [106443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"70121-1221-1","type":"NDC"}],"standard_charges":[{"gross_charge":104.09,"discounted_cash":104.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOCETAXEL 80 MG/4ML IV CONC [108122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"0409-0367-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.38,"discounted_cash":220.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DOFETILIDE 500 MCG PO CAPS [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-063-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG PO CAPS [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-5820-60","type":"NDC"}],"standard_charges":[{"gross_charge":35.31,"discounted_cash":35.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":35.31,"discounted_cash":35.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":35.31,"discounted_cash":35.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG PO CAPS [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-5820-43","type":"NDC"}],"standard_charges":[{"gross_charge":71.15,"discounted_cash":71.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":71.15,"discounted_cash":71.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":71.15,"discounted_cash":71.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 250 MCG PO CAPS [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72205-040-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 250 MCG PO CAPS [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59651-119-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 500 MCG PO CAPS [26967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72205-041-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 250 MCG PO CAPS [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-062-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOLUTEGRAVIR SODIUM 50 MG PO TABS [123360]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49702-228-13","type":"NDC"}],"standard_charges":[{"gross_charge":482.66,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"0143-9254-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9252-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9252-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DONEPEZIL HCL 5 MG PO TBDP [41135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-029-07","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL HCL 5 MG PO TBDP [41135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5276-64","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL HCL 5 MG PO TABS [18786]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-275-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":56.35,"discounted_cash":56.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 23 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL HCL 23 MG PO TABS [105906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-061-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 23 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DONEPEZIL HCL 10 MG PO TABS [18787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-276-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"DOPAMINE HCL 40 MG/ML IV SOLN [2595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-5820-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOFETILIDE 250 MCG PO CAPS [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-5810-60","type":"NDC"}],"standard_charges":[{"gross_charge":17.71,"discounted_cash":17.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":35.42,"discounted_cash":35.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":70.84,"discounted_cash":70.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML PO LIQD [2569]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54838-116-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML PO LIQD [2569]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-771-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML PO LIQD [2569]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-349-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 150 MG/15ML PO LIQD [2569]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0544-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD [147372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1870-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD [147372]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1870-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 100 MG PO CAPS [2566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-43002","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"DOCUSATE CALCIUM 240 MG PO CAPS [2565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-266-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"DOCUSATE CALCIUM 240 MG PO CAPS [2565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-260-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"DOCOSANOL 10 % EX CREA [29287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-681-07","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"DOCOSANOL 10 % EX CREA [29287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-624-07","type":"NDC"}],"standard_charges":[{"gross_charge":16.47,"discounted_cash":16.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"DOCETAXEL 80 MG/8ML IV SOLN [108907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"66758-050-02","type":"NDC"}],"standard_charges":[{"gross_charge":381.89,"discounted_cash":381.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"DOCETAXEL 80 MG/4ML IV CONC [108122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729-267-64","type":"NDC"}],"standard_charges":[{"gross_charge":373.43,"discounted_cash":373.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DOCETAXEL 80 MG/4ML IV CONC 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MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"DOFETILIDE 250 MCG PO CAPS [26966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0069-5810-43","type":"NDC"}],"standard_charges":[{"gross_charge":71.15,"discounted_cash":71.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":71.15,"discounted_cash":71.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":142.29,"discounted_cash":142.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG PO CAPS [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72205-039-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG PO CAPS [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-061-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOFETILIDE 125 MCG PO CAPS [26965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42794-044-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.91,"discounted_cash":18.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MCG"},{"gross_charge":37.82,"discounted_cash":37.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":75.63,"discounted_cash":75.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"DOCUSATE SODIUM 50 MG/5ML PO LIQD [36962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-544-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DULAGLUTIDE 1.5 MG/0.5ML SC SOAJ [155045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-1434-80","type":"NDC"}],"standard_charges":[{"gross_charge":1561.92,"discounted_cash":1561.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"DULAGLUTIDE 4.5 MG/0.5ML SC SOAJ 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[19604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-123-01","type":"NDC"}],"standard_charges":[{"gross_charge":325.26,"discounted_cash":325.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE HCL (NASAL) 0.1 % NA SOLN [19604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":1492.2,"discounted_cash":1492.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"EPINEPHRINE 8 MCG/ML INFUSION PREMIXED FOR ANES 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[123227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"54288-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":831.58,"discounted_cash":831.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"EPINEPHRINE PF 1 MG/ML IJ SOLN [136430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-103-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.96,"discounted_cash":66.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY [144810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329-3318-1","type":"NDC"}],"standard_charges":[{"gross_charge":92.8,"discounted_cash":92.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY [144810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"0409-4933-01","type":"NDC"}],"standard_charges":[{"gross_charge":70.3,"discounted_cash":70.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ [125101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49502-500-02","type":"NDC"}],"standard_charges":[{"gross_charge":1847.92,"discounted_cash":1847.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ [125101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49502-102-02","type":"NDC"}],"standard_charges":[{"gross_charge":899.39,"discounted_cash":899.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ [125101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49502-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":885.9,"discounted_cash":885.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ [125101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0115-1694-49","type":"NDC"}],"standard_charges":[{"gross_charge":850.28,"discounted_cash":850.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ [125101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-5986-19","type":"NDC"}],"standard_charges":[{"gross_charge":862.81,"discounted_cash":862.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY [144810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"0409-4933-11","type":"NDC"}],"standard_charges":[{"gross_charge":56.45,"discounted_cash":56.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPINEPHRINE PF 1 MG/ML IJ SOLN [136430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":52.82,"discounted_cash":52.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EPINEPHRINE-NACL 4-0.9 MG/250ML-% IV SOLN [148747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"42023-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":199.2,"discounted_cash":199.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"EPINEPHRINE-NACL 4-0.9 MG/250ML-% IV SOLN [148747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"9999-1903-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN [137171]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1308-01","type":"NDC"}],"standard_charges":[{"gross_charge":592.74,"discounted_cash":592.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1185.47,"discounted_cash":1185.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":2370.93,"discounted_cash":2370.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":3556.4,"discounted_cash":3556.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"EPOETIN ALFA 2000 UNIT/ML IJ SOLN [9939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-302-00","type":"NDC"}],"standard_charges":[{"gross_charge":1300.49,"discounted_cash":1300.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":2600.98,"discounted_cash":2600.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":5201.96,"discounted_cash":5201.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":7802.94,"discounted_cash":7802.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"EPOETIN ALFA 10000 UNIT/ML IJ SOLN [9938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q4081","type":"HCPCS"},{"code":"59676-310-01","type":"NDC"}],"standard_charges":[{"gross_charge":923.72,"discounted_cash":923.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1847.44,"discounted_cash":1847.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":3694.87,"discounted_cash":3694.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":5542.3,"discounted_cash":5542.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"EPLERENONE 25 MG PO TABS [36983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59762-1710-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EPLERENONE 25 MG PO TABS [36983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"31722-049-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EPLERENONE 25 MG PO TABS [36983]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16729-293-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ [125100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49502-501-02","type":"NDC"}],"standard_charges":[{"gross_charge":1837.19,"discounted_cash":1837.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"}]},{"description":"EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ [125100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49502-101-02","type":"NDC"}],"standard_charges":[{"gross_charge":899.39,"discounted_cash":899.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"}]},{"description":"EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ 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[29805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-308-84","type":"NDC"}],"standard_charges":[{"gross_charge":509.5,"discounted_cash":509.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN [82085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-182-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN 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Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":308.98,"discounted_cash":308.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"ESCITALOPRAM OXALATE 20 MG PO TABS [33513]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-282-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ESCITALOPRAM OXALATE 10 MG PO TABS [33512]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-196-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY [147706]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0075-0624-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ERTAPENEM SODIUM 1 G/10ML IJ (WET SOLR VIAL) [150447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023-221-85","type":"NDC"}],"standard_charges":[{"gross_charge":89.73,"discounted_cash":89.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ERLOTINIB HCL 150 MG PO TABS [125850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50242-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":1271.96,"discounted_cash":1271.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1271.96,"discounted_cash":1271.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"EPOETIN ALFA-EPBX 20000 UNIT/ML IJ SOLN [144328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1311-01","type":"NDC"}],"standard_charges":[{"gross_charge":560.99,"discounted_cash":560.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1121.97,"discounted_cash":1121.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":2243.94,"discounted_cash":2243.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":3365.91,"discounted_cash":3365.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN [137168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1305-01","type":"NDC"}],"standard_charges":[{"gross_charge":692.72,"discounted_cash":692.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1385.44,"discounted_cash":1385.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":2770.88,"discounted_cash":2770.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":4156.32,"discounted_cash":4156.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN [137171]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1318-10","type":"NDC"}],"standard_charges":[{"gross_charge":597.73,"discounted_cash":597.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1195.46,"discounted_cash":1195.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":2390.92,"discounted_cash":2390.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":3586.37,"discounted_cash":3586.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"EPOETIN ALFA-EPBX 3000 UNIT/ML IJ SOLN [137169]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1306-01","type":"NDC"}],"standard_charges":[{"gross_charge":5722.88,"discounted_cash":5722.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":11445.75,"discounted_cash":11445.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":22891.5,"discounted_cash":22891.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":34337.24,"discounted_cash":34337.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"ERLOTINIB HCL 100 MG PO TABS [125848]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50242-063-01","type":"NDC"}],"standard_charges":[{"gross_charge":1299.75,"discounted_cash":1299.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2599.5,"discounted_cash":2599.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"ERGOLOID MESYLATES 1 MG PO TABS [2864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-281-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.59,"discounted_cash":28.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ERGOCALCIFEROL 200 MCG (8000 UT)/ML PO SOLN [140970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-234-60","type":"NDC"}],"standard_charges":[{"gross_charge":465.84,"discounted_cash":465.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"ERENUMAB-AOOE 70 MG/ML SC SOAJ [137217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513-841-01","type":"NDC"}],"standard_charges":[{"gross_charge":8750.26,"discounted_cash":8750.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"},{"gross_charge":4375.13,"discounted_cash":4375.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ERENUMAB-AOOE 140 MG/ML SC SOAJ [139525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513-843-01","type":"NDC"}],"standard_charges":[{"gross_charge":4606.8,"discounted_cash":4606.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"}]},{"description":"ERENUMAB-AOOE 140 MG/ML SC SOAJ [139525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55513-843-00","type":"NDC"}],"standard_charges":[{"gross_charge":4606.8,"discounted_cash":4606.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 140 MG"}]},{"description":"EPOPROSTENOL SODIUM IN NEBU [400386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-0519-00","type":"NDC"}],"standard_charges":[{"gross_charge":387.28,"discounted_cash":387.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOPROSTENOL SODIUM 1.5 MG IV SOLR [15898]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0173-0519-00","type":"NDC"}],"standard_charges":[{"gross_charge":387.28,"discounted_cash":387.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNIT/ML IJ SOLN [137172]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5105","type":"HCPCS"},{"code":"0069-1309-01","type":"NDC"}],"standard_charges":[{"gross_charge":573.99,"discounted_cash":573.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1147.98,"discounted_cash":1147.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"},{"gross_charge":2295.95,"discounted_cash":2295.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40000 UNITS"},{"gross_charge":3443.92,"discounted_cash":3443.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60000 UNITS"}]},{"description":"DULAGLUTIDE 3 MG/0.5ML SC SOAJ [155046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-2236-01","type":"NDC"}],"standard_charges":[{"gross_charge":1415.96,"discounted_cash":1415.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY [147711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288-437-92","type":"NDC"}],"standard_charges":[{"gross_charge":90.58,"discounted_cash":90.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY [147711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323-655-99","type":"NDC"}],"standard_charges":[{"gross_charge":92.11,"discounted_cash":92.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-383-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43547-381-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51991-748-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"27241-099-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-3270-30","type":"NDC"}],"standard_charges":[{"gross_charge":44.26,"discounted_cash":44.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.26,"discounted_cash":44.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":44.26,"discounted_cash":44.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":44.26,"discounted_cash":44.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68180-296-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-596-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-415-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-2997-3","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-595-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-413-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-381-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43547-379-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 20 MG PO CPEP [39275]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"27241-097-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"27241-098-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-414-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-414-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 30 MG PO CPEP [39276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43547-380-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"DULOXETINE HCL 60 MG PO CPEP [39277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68180-296-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ENALAPRIL MALEATE 20 MG PO TABS [9926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-926-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENALAPRIL MALEATE 20 MG PO TABS [9926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64679-926-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENALAPRIL MALEATE 20 MG PO TABS [9926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-548-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENALAPRIL MALEATE 20 MG PO TABS [9926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5611-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENALAPRIL MALEATE 2.5 MG PO TABS [9925]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4037-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENALAPRIL MALEATE 10 MG PO TABS [9924]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4039-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENALAPRIL MALEATE 20 MG PO TABS [9926]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-713-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY [147710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288-436-88","type":"NDC"}],"standard_charges":[{"gross_charge":60.14,"discounted_cash":60.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY [147710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288-410-89","type":"NDC"}],"standard_charges":[{"gross_charge":60.14,"discounted_cash":60.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR [141703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9177","type":"HCPCS"},{"code":"51144-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":11920.67,"discounted_cash":11920.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ENEMA MINERAL OIL RE ENEM [31609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0132-0301-40","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"ENEMA 7-19 GM/118ML RE ENEM [2805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6320-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"ENEMA 7-19 GM/118ML RE ENEM [2805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0132-0201-40","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML IV SOLN [155067]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9786-10","type":"NDC"}],"standard_charges":[{"gross_charge":75.46,"discounted_cash":75.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENALAPRILAT 1.25 MG/ML IV SOLN [155067]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9786-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.02,"discounted_cash":76.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENALAPRIL MALEATE 5 MG PO TABS [9927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-546-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENALAPRIL MALEATE 5 MG PO TABS [9927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5502-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY [147711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288-437-91","type":"NDC"}],"standard_charges":[{"gross_charge":91.27,"discounted_cash":91.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ENALAPRIL MALEATE 10 MG PO TABS [9924]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-547-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ELTROMBOPAG OLAMINE 25 MG PO TABS [94579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0685-15","type":"NDC"}],"standard_charges":[{"gross_charge":1128.07,"discounted_cash":1128.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2256.14,"discounted_cash":2256.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":3384.2,"discounted_cash":3384.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ELOTUZUMAB 400 MG IV SOLR [129915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"0003-4522-11","type":"NDC"}],"standard_charges":[{"gross_charge":8836.89,"discounted_cash":8836.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ELOTUZUMAB 300 MG IV SOLR [129914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9176","type":"HCPCS"},{"code":"0003-2291-11","type":"NDC"}],"standard_charges":[{"gross_charge":6891.51,"discounted_cash":6891.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"EFAVIRENZ 600 MG PO TABS [32298]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"31722-504-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"EFAVIRENZ 600 MG PO TABS [32298]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0056-0510-30","type":"NDC"}],"standard_charges":[{"gross_charge":197.48,"discounted_cash":197.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ECULIZUMAB 300 MG/30ML IV SOLN [81696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1300","type":"HCPCS"},{"code":"25682-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":24453.57,"discounted_cash":24453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ECONAZOLE NITRATE 1 % EX CREA [9915]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-1303-1","type":"NDC"}],"standard_charges":[{"gross_charge":30.06,"discounted_cash":30.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"EAR WAX DROPS 6.5 % OT SOLN [2728]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49999-219-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"EAR WAX DROPS 6.5 % OT SOLN [2728]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-7362-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.63,"discounted_cash":27.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"DUTASTERIDE 0.5 MG PO CAPS [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42806-549-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG PO CAPS [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42806-549-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DUTASTERIDE 0.5 MG PO CAPS [34089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"31722-131-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"DURVALUMAB 120 MG/2.4ML IV SOLN [135803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"0310-4500-12","type":"NDC"}],"standard_charges":[{"gross_charge":5869.45,"discounted_cash":5869.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 ML"}]},{"description":"DURLOBACTAM SODIUM 0.5 G IV SOLR [408152178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68547-311-30","type":"NDC"}],"standard_charges":[{"gross_charge":556.27,"discounted_cash":556.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"ELVITEG-COBIC-EMTRICIT-TENOFDF 150-150-200-300 MG PO TABS [117930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1201-1","type":"NDC"}],"standard_charges":[{"gross_charge":918.07,"discounted_cash":918.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ENALAPRIL MALEATE 1 MG/ML PO SOLN [132831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-020-15","type":"NDC"}],"standard_charges":[{"gross_charge":1358.1,"discounted_cash":1358.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"EMTRICITAB-RILPIVIR-TENOFOV DF 200-25-300 MG PO TABS [111273]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1101-1","type":"NDC"}],"standard_charges":[{"gross_charge":796.48,"discounted_cash":796.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG PO TABS [39255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61958-0701-1","type":"NDC"}],"standard_charges":[{"gross_charge":382.43,"discounted_cash":382.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE-TENOFOVIR DF 200-300 MG PO TABS [39255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42385-953-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE-TENOFOVIR AF 200-25 MG PO TABS [130976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-2002-2","type":"NDC"}],"standard_charges":[{"gross_charge":458.33,"discounted_cash":458.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"EMTRICITABINE 200 MG PO CAPS [36252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-642-02","type":"NDC"}],"standard_charges":[{"gross_charge":91.36,"discounted_cash":91.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"EMTRICITABINE 200 MG PO CAPS [36252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-301-30","type":"NDC"}],"standard_charges":[{"gross_charge":89.74,"discounted_cash":89.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"EMPAGLIFLOZIN 25 MG PO TABS [126255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0153-90","type":"NDC"}],"standard_charges":[{"gross_charge":37.6,"discounted_cash":37.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":93.98,"discounted_cash":93.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"EMPAGLIFLOZIN 25 MG PO TABS [126255]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0153-30","type":"NDC"}],"standard_charges":[{"gross_charge":37.6,"discounted_cash":37.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":93.98,"discounted_cash":93.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"EMPAGLIFLOZIN 10 MG PO TABS [126253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0152-37","type":"NDC"}],"standard_charges":[{"gross_charge":124.07,"discounted_cash":124.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":310.16,"discounted_cash":310.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"EMPAGLIFLOZIN 10 MG PO TABS [126253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0152-30","type":"NDC"}],"standard_charges":[{"gross_charge":110.3,"discounted_cash":110.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":275.73,"discounted_cash":275.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"ELVITEG-COBIC-EMTRICIT-TENOFAF 150-150-200-10 MG PO TABS [129687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-1901-1","type":"NDC"}],"standard_charges":[{"gross_charge":875.18,"discounted_cash":875.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM INJ WR [40819736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"0548-5400-25","type":"NDC"}],"standard_charges":[{"gross_charge":75.27,"discounted_cash":75.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"ROSUVASTATIN CALCIUM 20 MG PO TABS [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-263-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN CALCIUM 20 MG PO TABS [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-263-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN CALCIUM 20 MG PO TABS [35135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG PO TABS [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-156-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN CALCIUM 40 MG PO TABS [35136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-885-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN [70476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4047-02","type":"NDC"}],"standard_charges":[{"gross_charge":266.95,"discounted_cash":266.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":533.9,"discounted_cash":533.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ROSUVASTATIN CALCIUM 40 MG PO TABS [35136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-005-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN CALCIUM 40 MG PO TABS [35136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-264-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN CALCIUM 40 MG PO TABS [35136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-264-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROSUVASTATIN CALCIUM 10 MG PO TABS [35134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-156-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROPINIROLE HCL ER 2 MG PO TB24 [92015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3658-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ROPINIROLE HCL 1 MG PO TABS [21689]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-255-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPINIROLE HCL 0.5 MG PO TABS [21800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-031-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPINIROLE HCL 0.25 MG PO TABS [21688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-253-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROPINIROLE HCL ER 2 MG PO TB24 [92015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-659-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN [18194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323-288-20","type":"NDC"}],"standard_charges":[{"gross_charge":119.37,"discounted_cash":119.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":159.16,"discounted_cash":159.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":238.74,"discounted_cash":238.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % EP SOLN [132738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"61553-937-02","type":"NDC"}],"standard_charges":[{"gross_charge":532.0,"discounted_cash":532.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % EP SOLN [132738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"15082-002-87","type":"NDC"}],"standard_charges":[{"gross_charge":254.5,"discounted_cash":254.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ROPIVACAINE HCL 7.5 MG/ML IJ SOLN 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[18193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"55150-199-20","type":"NDC"}],"standard_charges":[{"gross_charge":52.8,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN [18195]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323-286-43","type":"NDC"}],"standard_charges":[{"gross_charge":54.88,"discounted_cash":54.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN 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[151653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0069-2465-19","type":"NDC"}],"standard_charges":[{"gross_charge":1612.22,"discounted_cash":1612.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR [151653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0069-2465-10","type":"NDC"}],"standard_charges":[{"gross_charge":1657.65,"discounted_cash":1657.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR [151653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0069-2465-01","type":"NDC"}],"standard_charges":[{"gross_charge":1612.22,"discounted_cash":1612.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ROTIGOTINE 6 MG/24HR TD PT24 [82102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50474-805-03","type":"NDC"}],"standard_charges":[{"gross_charge":170.28,"discounted_cash":170.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"SAXAGLIPTIN HCL 2.5 MG PO TABS [99496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-6100-30","type":"NDC"}],"standard_charges":[{"gross_charge":96.67,"discounted_cash":96.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":193.34,"discounted_cash":193.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SAXAGLIPTIN HCL 2.5 MG PO TABS [99496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-726-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SCN GENTAMICIN 2 MG/ML STOCK SOLUTION [40840899938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-9999-85","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SCN GENTAMICIN 2 MG/ML STOCK SOLUTION [40840899938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-9999-75","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SCN AMPICILLIN 30 MG/ML STOCK SOLUTION [40840899936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-9999-65","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SCN AMPICILLIN 30 MG/ML STOCK SOLUTION [40840899936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-9999-55","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SCN AMOXICILLIN 125 MG/5ML PO SUSR [408453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9888-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SCN ACYCLOVIR 200 MG/5ML PO SUSP [4088970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"SBI/PROTEIN ISOLATE 5 G PO PACK [122937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"53703-100-03","type":"NDC"}],"standard_charges":[{"gross_charge":117.74,"discounted_cash":117.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"},{"gross_charge":235.47,"discounted_cash":235.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PACKET"},{"gross_charge":353.2,"discounted_cash":353.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 PACKET"},{"gross_charge":470.93,"discounted_cash":470.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 PACKET"}]},{"description":"SAXAGLIPTIN HCL 5 MG PO TABS [99497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-727-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SAXAGLIPTIN HCL 5 MG PO TABS [99497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-6105-30","type":"NDC"}],"standard_charges":[{"gross_charge":48.34,"discounted_cash":48.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":96.67,"discounted_cash":96.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RISPERIDONE MICROSPHERES ER 12.5 MG IM SRER [140787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458-309-01","type":"NDC"}],"standard_charges":[{"gross_charge":1555.76,"discounted_cash":1555.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3111.52,"discounted_cash":3111.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":4667.28,"discounted_cash":4667.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"}]},{"description":"RISPERIDONE 1 MG/ML PO SOLN [17377]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0063-44","type":"NDC"}],"standard_charges":[{"gross_charge":179.28,"discounted_cash":179.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":179.28,"discounted_cash":179.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":179.28,"discounted_cash":179.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":179.28,"discounted_cash":179.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RISPERIDONE 1 MG PO TBDP [35687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-020-22","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"RISPERIDONE 1 MG PO TABS [18313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-114-14","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RISPERIDONE MICROSPHERES ER 12.5 MG IM SRER [140787]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458-309-11","type":"NDC"}],"standard_charges":[{"gross_charge":1869.83,"discounted_cash":1869.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":3739.66,"discounted_cash":3739.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":5609.49,"discounted_cash":5609.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"}]},{"description":"RITONAVIR 100 MG PO TABS [100995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-420-95","type":"NDC"}],"standard_charges":[{"gross_charge":45.32,"discounted_cash":45.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":90.63,"discounted_cash":90.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":135.94,"discounted_cash":135.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":181.25,"discounted_cash":181.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":226.56,"discounted_cash":226.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":271.88,"discounted_cash":271.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RITONAVIR 100 MG PO TABS [100995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-420-25","type":"NDC"}],"standard_charges":[{"gross_charge":41.9,"discounted_cash":41.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":83.79,"discounted_cash":83.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":125.68,"discounted_cash":125.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":167.57,"discounted_cash":167.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":209.46,"discounted_cash":209.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":251.36,"discounted_cash":251.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RISPERIDONE MICROSPHERES ER 50 MG IM SRER [140790]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458-308-11","type":"NDC"}],"standard_charges":[{"gross_charge":4387.71,"discounted_cash":4387.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RISPERIDONE MICROSPHERES ER 37.5 MG IM SRER [140789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458-307-11","type":"NDC"}],"standard_charges":[{"gross_charge":5608.97,"discounted_cash":5608.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"}]},{"description":"RISPERIDONE MICROSPHERES ER 25 MG IM SRER [140788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458-306-11","type":"NDC"}],"standard_charges":[{"gross_charge":3764.2,"discounted_cash":3764.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"RISPERIDONE MICROSPHERES ER 25 MG IM SRER [140788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2794","type":"HCPCS"},{"code":"50458-306-01","type":"NDC"}],"standard_charges":[{"gross_charge":1819.01,"discounted_cash":1819.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"RISPERIDONE 1 MG PO TABS [18313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-341-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"RIMABOTULINUMTOXINB 5000 UNIT/ML IM SOLN [29449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0587","type":"HCPCS"},{"code":"10454-711-10","type":"NDC"}],"standard_charges":[{"gross_charge":4102.22,"discounted_cash":4102.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RILUZOLE 50 MG PO TABS [16124]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-286-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RILUZOLE 50 MG PO TABS [16124]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-538-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RILPIVIRINE HCL 25 MG PO TABS [109909]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59676-278-01","type":"NDC"}],"standard_charges":[{"gross_charge":292.37,"discounted_cash":292.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"RIFAXIMIN 550 MG PO TABS [104604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-303-03","type":"NDC"}],"standard_charges":[{"gross_charge":359.45,"discounted_cash":359.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 MG"}]},{"description":"RIFAXIMIN 550 MG PO TABS [104604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-303-02","type":"NDC"}],"standard_charges":[{"gross_charge":185.91,"discounted_cash":185.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 MG"}]},{"description":"RIFAXIMIN 200 MG PO TABS [39063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-301-03","type":"NDC"}],"standard_charges":[{"gross_charge":69.91,"discounted_cash":69.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":209.72,"discounted_cash":209.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 550 MG"}]},{"description":"RIFAPENTINE 150 MG PO TABS [23365]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0088-2102-24","type":"NDC"}],"standard_charges":[{"gross_charge":117.44,"discounted_cash":117.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"},{"gross_charge":176.15,"discounted_cash":176.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"RIFAMPIN 600 MG IV SOLR [11291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-445-60","type":"NDC"}],"standard_charges":[{"gross_charge":186.49,"discounted_cash":186.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":372.97,"discounted_cash":372.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 600 MG IV SOLR [11291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-351-20","type":"NDC"}],"standard_charges":[{"gross_charge":172.17,"discounted_cash":172.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":344.34,"discounted_cash":344.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIFAMPIN 300 MG PO CAPS [11293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-659-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RISAQUAD PO CAPS [89376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-147-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"RISAQUAD PO CAPS [89376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71351-020-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"RISEDRONATE SODIUM 30 MG PO TABS [23015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0093-3100-56","type":"NDC"}],"standard_charges":[{"gross_charge":234.83,"discounted_cash":234.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":273.96,"discounted_cash":273.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":39.14,"discounted_cash":39.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RISPERIDONE 0.5 MG PO TBDP [35686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-010-32","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"RISPERIDONE 0.5 MG PO TABS [25520]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-340-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"RISEDRONATE SODIUM 5 MG PO TABS [27112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"33342-107-07","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":85.75,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RISAQUAD-2 PO CAPS [99772]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-156-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"RITONAVIR 100 MG PO TABS [100995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-687-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.45,"discounted_cash":18.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.67,"discounted_cash":27.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":36.89,"discounted_cash":36.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":46.12,"discounted_cash":46.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":55.34,"discounted_cash":55.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RIZATRIPTAN BENZOATE 10 MG PO TBDP [27630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69452-157-73","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RIZATRIPTAN BENZOATE 10 MG PO TBDP [27630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51991-363-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RIZATRIPTAN BENZOATE 10 MG PO TBDP [27630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51991-363-78","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG PO CAPS [28278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72241-011-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG PO CAPS [28278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51991-793-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"RIVASTIGMINE 9.5 MG/24HR TD PT24 [82505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-898-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIZATRIPTAN BENZOATE 10 MG PO TBDP [27630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69452-157-74","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RIVASTIGMINE 9.5 MG/24HR TD PT24 [82505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-898-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG PO TBDP [27629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51991-362-99","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ROPINIROLE HCL 0.25 MG PO TABS [21688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6373-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY [139827]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513-998-02","type":"NDC"}],"standard_charges":[{"gross_charge":12085.26,"discounted_cash":12085.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 210 MG"}]},{"description":"ROMOSOZUMAB-AQQG 105 MG/1.17ML SC SOSY [139827]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513-880-02","type":"NDC"}],"standard_charges":[{"gross_charge":15085.26,"discounted_cash":15085.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 210 MG"}]},{"description":"ROFLUMILAST 500 MCG PO TABS [109401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-200-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"ROFLUMILAST 500 MCG PO TABS [109401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-969-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"ROFLUMILAST 500 MCG PO TABS [109401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-0095-30","type":"NDC"}],"standard_charges":[{"gross_charge":86.5,"discounted_cash":86.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG PO TBDP [27629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69452-156-74","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG PO TBDP [27629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69452-156-73","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RIZATRIPTAN BENZOATE 5 MG PO TBDP [27629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65862-625-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RIVASTIGMINE 9.5 MG/24HR TD PT24 [82505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7309-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 9.5 MG/24HR TD PT24 [82505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0502-61","type":"NDC"}],"standard_charges":[{"gross_charge":54.72,"discounted_cash":54.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVAROXABAN 15 MG PO TABS [112792]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-578-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.25,"discounted_cash":51.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":76.88,"discounted_cash":76.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.82,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":102.5,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVAROXABAN 10 MG PO TABS [110250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-580-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.88,"discounted_cash":76.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":115.31,"discounted_cash":115.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":19.22,"discounted_cash":19.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":153.75,"discounted_cash":153.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RITUXIMAB-PVVR 500 MG/50ML IV SOLN [141790]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"0069-0249-01","type":"NDC"}],"standard_charges":[{"gross_charge":6075.9,"discounted_cash":6075.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"RITUXIMAB-PVVR 100 MG/10ML IV SOLN [141789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"0069-0238-01","type":"NDC"}],"standard_charges":[{"gross_charge":4530.86,"discounted_cash":4530.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RITUXIMAB-ABBS 500 MG/50ML IV SOLN [141403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459-104-50","type":"NDC"}],"standard_charges":[{"gross_charge":10487.48,"discounted_cash":10487.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"RITUXIMAB-ABBS 100 MG/10ML IV SOLN [141402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459-103-10","type":"NDC"}],"standard_charges":[{"gross_charge":3624.56,"discounted_cash":3624.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RITUXIMAB 500 MG/50ML IV SOLN [129176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242-053-06","type":"NDC"}],"standard_charges":[{"gross_charge":17636.58,"discounted_cash":17636.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"RITUXIMAB 100 MG/10ML IV SOLN [129175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242-051-21","type":"NDC"}],"standard_charges":[{"gross_charge":3562.52,"discounted_cash":3562.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RIVASTIGMINE 9.5 MG/24HR TD PT24 [82505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9071-16","type":"NDC"}],"standard_charges":[{"gross_charge":18.13,"discounted_cash":18.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVAROXABAN 2.5 MG PO TABS [138213]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-577-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.57,"discounted_cash":140.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":210.86,"discounted_cash":210.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":35.15,"discounted_cash":35.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":281.14,"discounted_cash":281.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"RIVASTIGMINE 4.6 MG/24HR TD PT24 [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-304-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.77,"discounted_cash":28.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24HR TD PT24 [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9070-93","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 4.6 MG/24HR TD PT24 [82504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9070-16","type":"NDC"}],"standard_charges":[{"gross_charge":18.16,"discounted_cash":18.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 13.3 MG/24HR TD PT24 [117993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7313-58","type":"NDC"}],"standard_charges":[{"gross_charge":20.18,"discounted_cash":20.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVASTIGMINE 13.3 MG/24HR TD PT24 [117993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-9072-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"RIVAROXABAN 20 MG PO TABS [112913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.43,"discounted_cash":38.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":57.64,"discounted_cash":57.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN [27838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"79672-613-30","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN MINI-BAG PLUS [4082027839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0553-11","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN MINI-BAG PLUS 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NDC EA = 4 ML"}]},{"description":"SODIUM CHLORIDE 1 G PO TABS [7328]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0223-1760-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN NON-DEHP [4082027838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"65219-472-05","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN NON-DEHP 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[4082027838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-5802-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN NON-DEHP [4082027838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0264-5802-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN MINI-BAG PLUS 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[7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3352-1","type":"NDC"}],"standard_charges":[{"gross_charge":122.2,"discounted_cash":122.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":122.2,"discounted_cash":122.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SILODOSIN 4 MG PO CAPS [96984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2623-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | 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[41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-788-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL CITRATE 20 MG PO TABS [41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-788-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL CITRATE 20 MG PO TABS [41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-416-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL CITRATE 20 MG PO TABS [41832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6671-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"SILDENAFIL CITRATE 10 MG/12.5ML IV SOLN [100417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0069-0338-01","type":"NDC"}],"standard_charges":[{"gross_charge":931.15,"discounted_cash":931.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":931.15,"discounted_cash":931.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG PO TABS [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-058-27","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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[96984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1421-3","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"SILODOSIN 4 MG PO CAPS [96984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-009-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA 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[7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59762-0131-4","type":"NDC"}],"standard_charges":[{"gross_charge":294.62,"discounted_cash":294.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 G"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"59762-0131-2","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-210-50","type":"NDC"}],"standard_charges":[{"gross_charge":42.9,"discounted_cash":42.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-210-40","type":"NDC"}],"standard_charges":[{"gross_charge":163.2,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 G"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-210-25","type":"NDC"}],"standard_charges":[{"gross_charge":31.95,"discounted_cash":31.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"}]},{"description":"SILVER NITRATE-POT NITRATE 75-25 % EX MISC [11359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"12870-0001-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SILTUXIMAB 400 MG IV SOLR [125561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2860","type":"HCPCS"},{"code":"73090-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":17644.33,"discounted_cash":17644.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SILTUXIMAB 100 MG IV SOLR [125560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2860","type":"HCPCS"},{"code":"73090-420-01","type":"NDC"}],"standard_charges":[{"gross_charge":4430.81,"discounted_cash":4430.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SILODOSIN 8 MG PO CAPS [96985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1420-3","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"SILODOSIN 8 MG PO CAPS [96985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-636-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"SEVELAMER CARBONATE 800 MG PO TABS [89201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-215-58","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 2.4 G PO PACK [99695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-479-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"}]},{"description":"SERTRALINE HCL 25 MG PO TABS [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE HCL 25 MG PO TABS [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-611-04","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE HCL 25 MG PO TABS [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0049-4960-30","type":"NDC"}],"standard_charges":[{"gross_charge":197.28,"discounted_cash":197.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.32,"discounted_cash":49.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":98.64,"discounted_cash":98.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG PO TABS [24216]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1248-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"}]},{"description":"SENNOSIDES 8.8 MG/5ML PO SYRP [15168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-219-40","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SENNOSIDES 8.8 MG/5ML PO SYRP [15168]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-219-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA [7224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67877-124-20","type":"NDC"}],"standard_charges":[{"gross_charge":70.44,"discounted_cash":70.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 G"}]},{"description":"SERTRALINE HCL 25 MG PO TABS [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-231-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SEVELAMER CARBONATE 2.4 G PO PACK [99695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1366-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"}]},{"description":"SEVELAMER CARBONATE 2.4 G PO PACK [99695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1366-29","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"}]},{"description":"SEVELAMER CARBONATE 0.8 G PO PACK [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-930-90","type":"NDC"}],"standard_charges":[{"gross_charge":22.35,"discounted_cash":22.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":33.52,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SEVELAMER CARBONATE 0.8 G PO PACK [99694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-930-08","type":"NDC"}],"standard_charges":[{"gross_charge":99.8,"discounted_cash":99.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1600 MG"},{"gross_charge":149.69,"discounted_cash":149.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2400 MG"},{"gross_charge":49.9,"discounted_cash":49.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"SERTRALINE HCL 50 MG PO TABS [11351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-012-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SERTRALINE HCL 25 MG PO TABS [19882]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-833-12","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SIMETHICONE 40 MG/0.6ML PO SUSP [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1303-75","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 40 MG/0.6ML PO SUSP [7228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"56184-12041","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SIMETHICONE 80 MG PO CHEW [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-118-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SODIUM BICARBONATE 650 MG PO TABS [7313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367-258-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1300 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"SODIUM BICARBONATE 650 MG PO TABS [7313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-528-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1300 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-083-05","type":"NDC"}],"standard_charges":[{"gross_charge":2977.6,"discounted_cash":2977.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MEQ"},{"gross_charge":1488.8,"discounted_cash":1488.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5012-4","type":"NDC"}],"standard_charges":[{"gross_charge":1208.0,"discounted_cash":1208.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MEQ"},{"gross_charge":604.0,"discounted_cash":604.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5012-1","type":"NDC"}],"standard_charges":[{"gross_charge":1217.72,"discounted_cash":1217.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MEQ"},{"gross_charge":608.86,"discounted_cash":608.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-5555-12","type":"NDC"}],"standard_charges":[{"gross_charge":2047.6,"discounted_cash":2047.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MEQ"},{"gross_charge":1023.8,"discounted_cash":1023.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN [7306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-5534-24","type":"NDC"}],"standard_charges":[{"gross_charge":2382.8,"discounted_cash":2382.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MEQ"},{"gross_charge":1191.4,"discounted_cash":1191.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7299-83","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM BICARBONATE 8.4 % ABBOJECT IV SOLN [4087309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4900-14","type":"NDC"}],"standard_charges":[{"gross_charge":410.95,"discounted_cash":410.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":821.9,"discounted_cash":821.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % ABBOJECT IV SOLN [4087309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4900-24","type":"NDC"}],"standard_charges":[{"gross_charge":243.9,"discounted_cash":243.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":487.79,"discounted_cash":487.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72572-740-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":59.35,"discounted_cash":59.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-089-50","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":60.7,"discounted_cash":60.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5011-4","type":"NDC"}],"standard_charges":[{"gross_charge":183.7,"discounted_cash":183.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":367.4,"discounted_cash":367.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5011-1","type":"NDC"}],"standard_charges":[{"gross_charge":148.38,"discounted_cash":148.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":296.75,"discounted_cash":296.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51754-5001-4","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":58.9,"discounted_cash":58.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN [7309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-6625-22","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MEQ"},{"gross_charge":83.21,"discounted_cash":83.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MEQ"}]},{"description":"SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7299-73","type":"NDC"}],"standard_charges":[{"gross_charge":45.64,"discounted_cash":45.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3299-06","type":"NDC"}],"standard_charges":[{"gross_charge":65.8,"discounted_cash":65.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SIROLIMUS 1 MG PO TABS [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0008-1041-05","type":"NDC"}],"standard_charges":[{"gross_charge":71.79,"discounted_cash":71.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":71.79,"discounted_cash":71.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":143.58,"discounted_cash":143.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SIROLIMUS 0.5 MG PO TABS [104764]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68462-682-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.17,"discounted_cash":20.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":40.34,"discounted_cash":40.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":80.67,"discounted_cash":80.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SINCALIDE 5 MCG IJ SOLR [11368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-248-05","type":"NDC"}],"standard_charges":[{"gross_charge":635.52,"discounted_cash":635.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SINCALIDE 5 MCG IJ SOLR [11368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-248-01","type":"NDC"}],"standard_charges":[{"gross_charge":635.52,"discounted_cash":635.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SINCALIDE 5 MCG IJ SOLR [11368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-579-01","type":"NDC"}],"standard_charges":[{"gross_charge":554.65,"discounted_cash":554.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SINCALIDE 5 MCG IJ SOLR [11368]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-0556-15","type":"NDC"}],"standard_charges":[{"gross_charge":773.04,"discounted_cash":773.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SIMETHICONE 80 MG PO CHEW [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000-0434-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIMETHICONE 80 MG PO CHEW [7227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-791-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SIROLIMUS 1 MG PO TABS [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0008-1041-10","type":"NDC"}],"standard_charges":[{"gross_charge":141.8,"discounted_cash":141.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":141.8,"discounted_cash":141.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":283.59,"discounted_cash":283.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SODIUM ACETATE 2 MEQ/ML IV SOLN [7301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3299-16","type":"NDC"}],"standard_charges":[{"gross_charge":60.7,"discounted_cash":60.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SIROLIMUS 1 MG PO TABS [28958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55111-653-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.57,"discounted_cash":12.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":25.14,"discounted_cash":25.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":50.27,"discounted_cash":50.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"SOD PHOS MONO-SOD PHOS DIBASIC 1.102-0.398 G PO TABS [29469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65649-701-41","type":"NDC"}],"standard_charges":[{"gross_charge":148.97,"discounted_cash":148.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN [11394]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1190-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":25.92,"discounted_cash":25.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SITAGLIPTIN PHOSPHATE 50 MG PO TABS [77616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-0112-54","type":"NDC"}],"standard_charges":[{"gross_charge":130.08,"discounted_cash":130.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":65.04,"discounted_cash":65.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":65.04,"discounted_cash":65.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SITAGLIPTIN PHOSPHATE 50 MG PO TABS [77616]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-0112-31","type":"NDC"}],"standard_charges":[{"gross_charge":188.75,"discounted_cash":188.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":47.19,"discounted_cash":47.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":94.38,"discounted_cash":94.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SITAGLIPTIN PHOSPHATE 100 MG PO TABS [77617]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0006-0277-28","type":"NDC"}],"standard_charges":[{"gross_charge":69.56,"discounted_cash":69.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":17.39,"discounted_cash":17.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":34.78,"discounted_cash":34.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SIROLIMUS 1 MG/ML PO SOLN [26336]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7520","type":"HCPCS"},{"code":"66689-347-02","type":"NDC"}],"standard_charges":[{"gross_charge":3119.4,"discounted_cash":3119.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"RIFAMPIN 25 MG/ML PO SUSP [40840044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1165-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.23,"discounted_cash":65.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"RIFAMPIN 150 MG PO CAPS [11292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-575-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 5 MG PO TABS [6583]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50268-684-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG PO TABS [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60219-2039-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG PO TABS [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59746-115-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROGESTERONE 100 MG PO CAPS [126747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-152-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":23.64,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG PO TABS [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50268-685-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG PO TABS [6582]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50268-685-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN [139415]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-778-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN [139415]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-778-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROGESTERONE 50 MG/ML IM OIL [6597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-306-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 12.5 MG RE SUPP [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-5296-1","type":"NDC"}],"standard_charges":[{"gross_charge":21.37,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":42.74,"discounted_cash":42.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":85.47,"discounted_cash":85.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 12.5 MG RE SUPP [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-758-30","type":"NDC"}],"standard_charges":[{"gross_charge":36.33,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":72.66,"discounted_cash":72.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":145.32,"discounted_cash":145.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 12.5 MG RE SUPP [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-758-00","type":"NDC"}],"standard_charges":[{"gross_charge":44.46,"discounted_cash":44.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":88.91,"discounted_cash":88.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":177.82,"discounted_cash":177.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 12.5 MG RE SUPP [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0536-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 12.5 MG RE SUPP [11143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0536-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN [139415]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-790-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRIMIDONE 50 MG PO TABS [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1301-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMIDONE 250 MG PO TABS [6544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-545-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PRIMAQUINE PHOSPHATE 26.3 (15 BASE) MG PO TABS [146086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PRIMAQUINE PHOSPHATE 26.3 (15 BASE) MG PO TABS [146086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0024-1596-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PRENATAL-U 106.5-1 MG PO CAPS [35211]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60258-179-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"PREGABALIN 75 MG PO CAPS [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-612-90","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 75 MG PO CAPS [42164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7000-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PRIMIDONE 50 MG PO TABS [11129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-544-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN [139415]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-790-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROCHLORPERAZINE 25 MG RE SUPP [11138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7226-12","type":"NDC"}],"standard_charges":[{"gross_charge":36.14,"discounted_cash":36.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROCAINAMIDE HCL 500 MG/ML IJ SOLN [6563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"14789-900-07","type":"NDC"}],"standard_charges":[{"gross_charge":356.38,"discounted_cash":356.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCAINAMIDE HCL 500 MG/ML IJ SOLN [6563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"14789-900-02","type":"NDC"}],"standard_charges":[{"gross_charge":3395.31,"discounted_cash":3395.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCAINAMIDE HCL 500 MG/ML IJ SOLN [6563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1903-01","type":"NDC"}],"standard_charges":[{"gross_charge":437.43,"discounted_cash":437.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCAINAMIDE HCL 100 MG/ML IJ SOLN [6562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1902-01","type":"NDC"}],"standard_charges":[{"gross_charge":345.69,"discounted_cash":345.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROBENECID 500 MG PO TABS [6561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5347-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PROBENECID 500 MG PO TABS [6561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1367-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.08,"discounted_cash":36.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":18.04,"discounted_cash":18.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PROBENECID 500 MG PO TABS [6561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0156-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0591-5307-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPAFENONE HCL 150 MG PO TABS [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0582-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROMETHAZINE HCL 6.25 MG/5ML PO SOLN [97609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-801-16","type":"NDC"}],"standard_charges":[{"gross_charge":55.09,"discounted_cash":55.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE HCL 6.25 MG/5ML PO SOLN [97609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27808-051-02","type":"NDC"}],"standard_charges":[{"gross_charge":62.44,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PROMETHAZINE HCL 50 MG RE SUPP [6624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0132-12","type":"NDC"}],"standard_charges":[{"gross_charge":149.82,"discounted_cash":149.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":149.82,"discounted_cash":149.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":149.82,"discounted_cash":149.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6208-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6082-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-1495-35","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN [6618]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-0955-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PROPAFENONE HCL 150 MG PO TABS [11146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-230-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PROPAFENONE HCL ER 225 MG PO CP12 [37643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-408-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":17.7,"discounted_cash":17.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":23.14,"discounted_cash":23.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 425 MG"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL [130447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0409-4699-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL [130447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0069-0248-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN [6644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-016-01","type":"NDC"}],"standard_charges":[{"gross_charge":148.77,"discounted_cash":148.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN [6644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-263-12","type":"NDC"}],"standard_charges":[{"gross_charge":207.72,"discounted_cash":207.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PROPAFENONE HCL ER 425 MG PO CP12 [37645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-410-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 425 MG"}]},{"description":"PROPAFENONE HCL ER 325 MG PO CP12 [37644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69680-131-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":16.02,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 425 MG"}]},{"description":"PROPAFENONE HCL ER 325 MG PO CP12 [37644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-409-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":16.02,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 425 MG"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-5297-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":21.37,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.74,"discounted_cash":42.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68084-155-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68084-155-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65162-521-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"10702-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0904-6461-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71335-1139-6","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-759-30","type":"NDC"}],"standard_charges":[{"gross_charge":18.17,"discounted_cash":18.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":36.33,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":72.66,"discounted_cash":72.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0526-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG RE SUPP [11144]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0526-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":19.91,"discounted_cash":19.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":39.81,"discounted_cash":39.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72189-176-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROMETHAZINE HCL 25 MG PO TABS [6622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72189-176-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL [130447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0641-6196-01","type":"NDC"}],"standard_charges":[{"gross_charge":189.31,"discounted_cash":189.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PREGABALIN 50 MG PO CAPS [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-484-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0603-5338-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0017-29","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-0017-29","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0017-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-0017-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0017-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-0017-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0603-5338-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 20 MG PO TABS [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0591-5443-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 20 MG PO TABS [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0591-5443-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60687-134-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60687-134-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-173-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 10 MG PO TABS [6494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59746-173-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"60219-1705-1","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":245.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-7003-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"60432-212-08","type":"NDC"}],"standard_charges":[{"gross_charge":247.43,"discounted_cash":247.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-212-08","type":"NDC"}],"standard_charges":[{"gross_charge":247.43,"discounted_cash":247.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":247.43,"discounted_cash":247.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"17856-815-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-815-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"17856-759-05","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-759-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"0121-0759-08","type":"NDC"}],"standard_charges":[{"gross_charge":14.64,"discounted_cash":14.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0759-08","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP [6487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60758-119-10","type":"NDC"}],"standard_charges":[{"gross_charge":306.42,"discounted_cash":306.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN [29302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"9999-7003-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PREDNISONE 20 MG PO TABS [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70954-060-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-4741-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60219-1705-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-171-06","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":245.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59746-171-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-8739-25","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":245.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-8739-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 1 MG PO TABS [6493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-4741-25","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":245.0,"discounted_cash":245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 20 MG PO TABS [6496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"70954-060-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREGABALIN 25 MG PO CAPS [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6991-61","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 25 MG PO CAPS [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6991-04","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 100 MG PO CAPS [42165]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7001-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.57,"discounted_cash":27.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PREGABALIN 25 MG PO CAPS [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-473-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"70954-061-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PREGABALIN 50 MG PO CAPS [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-484-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 50 MG PO CAPS [42163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6992-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREGABALIN 25 MG PO CAPS [42162]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-473-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70954-061-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"PREDNISONE 5 MG PO TABS [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-172-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 5 MG PO TABS [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59746-172-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG PO TABS [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59746-172-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 5 MG PO TABS [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59746-172-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG PO TABS [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-4728-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 5 MG PO TABS [6497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-4728-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PREDNISONE 5 MG/5ML PO SOLN [6492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-3722-50","type":"NDC"}],"standard_charges":[{"gross_charge":32.1,"discounted_cash":32.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":64.21,"discounted_cash":64.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-0019-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"59651-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59651-489-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0019-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0054-0019-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"PREDNISONE 50 MG PO TABS [6498]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7512","type":"HCPCS"},{"code":"0054-0019-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SORAFENIB TOSYLATE 200 MG PO TABS [43675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50419-488-58","type":"NDC"}],"standard_charges":[{"gross_charge":866.1,"discounted_cash":866.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL [130447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598-549-52","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"QUINAPRIL HCL 10 MG PO TABS [11251]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43547-411-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUETIAPINE FUMARATE ER 50 MG PO TB24 [95676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-160-60","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE FUMARATE ER 50 MG PO TB24 [95676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-132-12","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE FUMARATE ER 300 MG PO TB24 [82090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-601-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUINAPRIL HCL 20 MG PO TABS [11252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62135-486-90","type":"NDC"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":28.98,"discounted_cash":28.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":57.95,"discounted_cash":57.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RALOXIFENE HCL 60 MG PO TABS [22143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6902-04","type":"NDC"}],"standard_charges":[{"gross_charge":26.27,"discounted_cash":26.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"RACEPINEPHRINE HCL 2.25 % IN NEBU [113159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0487-5901-99","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RABIES VACCINE, PCEC IM SUSR [22120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50632-010-01","type":"NDC"}],"standard_charges":[{"gross_charge":2137.12,"discounted_cash":2137.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"QUININE SULFATE 324 MG PO CAPS [6781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-238-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 648 MG"}]},{"description":"QUINIDINE SULFATE 300 MG PO TABS [6778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-512-30","type":"NDC"}],"standard_charges":[{"gross_charge":75.21,"discounted_cash":75.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"QUINIDINE SULFATE 200 MG PO TABS [6777]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-4346-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"QUINAPRIL HCL 20 MG PO TABS [11252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68001-187-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"QUETIAPINE FUMARATE ER 300 MG PO TB24 [82090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-096-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE FUMARATE ER 200 MG PO TB24 [82089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-513-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2063-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-250-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"RALOXIFENE HCL 60 MG PO TABS [22143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-266-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-147-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE FUMARATE ER 150 MG PO TB24 [96233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-599-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"QUETIAPINE FUMARATE ER 150 MG PO TB24 [96233]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-512-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"QUETIAPINE FUMARATE 25 MG PO TABS [21823]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-902-88","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":196.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"RALOXIFENE HCL 60 MG PO TABS [22143]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-266-21","type":"NDC"}],"standard_charges":[{"gross_charge":26.81,"discounted_cash":26.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"RALTEGRAVIR POTASSIUM 100 MG PO CHEW [117418]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0477-61","type":"NDC"}],"standard_charges":[{"gross_charge":38.11,"discounted_cash":38.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RALTEGRAVIR POTASSIUM 400 MG PO TABS [88608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0227-61","type":"NDC"}],"standard_charges":[{"gross_charge":216.23,"discounted_cash":216.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNIT/2ML IJ SOSY [127809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2791","type":"HCPCS"},{"code":"44206-300-01","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE (300 MCG; 1500 UNITS)"},{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 SYRINGES (600 MCG; 3000 UNITS)"}]},{"description":"REVEFENACIN 175 MCG/3ML IN SOLN [138653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J7677","type":"HCPCS"},{"code":"49502-806-93","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 175 MCG"}]},{"description":"RESLIZUMAB 100 MG/10ML IV SOLN [130935]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2786","type":"HCPCS"},{"code":"59310-610-31","type":"NDC"}],"standard_charges":[{"gross_charge":4176.07,"discounted_cash":4176.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"REPAGLINIDE 1 MG PO TABS [22586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-671-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REPAGLINIDE 1 MG PO TABS [22586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-745-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REPAGLINIDE 1 MG PO TABS [22586]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0241-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"REMIFENTANIL HCL 50 MCG/ML INFUSION - ANES [408408121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"67457-198-03","type":"NDC"}],"standard_charges":[{"gross_charge":391.34,"discounted_cash":391.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"REMIFENTANIL HCL 2 MG IV SOLR [18400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"67457-198-05","type":"NDC"}],"standard_charges":[{"gross_charge":757.83,"discounted_cash":757.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNIT/2ML IJ SOSY [127809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2791","type":"HCPCS"},{"code":"44206-300-10","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE (300 MCG; 1500 UNITS)"},{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 SYRINGES (600 MCG; 3000 UNITS)"}]},{"description":"REMIFENTANIL HCL 1 MG IV SOLR [18398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-723-03","type":"NDC"}],"standard_charges":[{"gross_charge":237.45,"discounted_cash":237.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY [127808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0562-7805-00","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE (300 MCG; 1500 UNITS)"},{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 SYRINGES (600 MCG; 3000 UNITS)"}]},{"description":"RIFABUTIN 150 MG PO CAPS [11290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-041-10","type":"NDC"}],"standard_charges":[{"gross_charge":110.07,"discounted_cash":110.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"RIFABUTIN 150 MG PO CAPS [11290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1350-1","type":"NDC"}],"standard_charges":[{"gross_charge":109.35,"discounted_cash":109.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"RIFABUTIN 150 MG PO CAPS [11290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0013-5301-17","type":"NDC"}],"standard_charges":[{"gross_charge":322.53,"discounted_cash":322.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"RIBAVIRIN 6 G IN SOLR [11285]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0187-0007-14","type":"NDC"}],"standard_charges":[{"gross_charge":16264.54,"discounted_cash":16264.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":16264.54,"discounted_cash":16264.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 G"}]},{"description":"RIBAVIRIN 200 MG PO CAPS [11286]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65862-290-84","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"RHO D IMMUNE GLOBULIN 250 UNITS IM SOSY [127807]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0562-7806-01","type":"NDC"}],"standard_charges":[{"gross_charge":248.61,"discounted_cash":248.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY [127808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0562-7805-05","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE (300 MCG; 1500 UNITS)"},{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 SYRINGES (600 MCG; 3000 UNITS)"}]},{"description":"RHO D IMMUNE GLOBULIN 1500 UNITS IM SOSY [127808]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0562-7805-01","type":"NDC"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE (300 MCG; 1500 UNITS)"},{"gross_charge":180.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 SYRINGES (600 MCG; 3000 UNITS)"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-904-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"REMIFENTANIL HCL 1 MG IV SOLR [18398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"63323-723-01","type":"NDC"}],"standard_charges":[{"gross_charge":267.04,"discounted_cash":267.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"REMDESIVIR 100 MG IV SOLR [142682]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0248","type":"HCPCS"},{"code":"61958-2901-2","type":"NDC"}],"standard_charges":[{"gross_charge":4100.74,"discounted_cash":4100.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RAMIPRIL 5 MG PO CAPS [11261]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-224-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 2.5 MG PO CAPS [11260]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-429-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 10 MG PO CAPS [11259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-225-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMIPRIL 1.25 MG PO CAPS [11258]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-474-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"RAMELTEON 8 MG PO TABS [42064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-235-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"REMIFENTANIL HCL 1 MG IV SOLR [18398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0143-9391-01","type":"NDC"}],"standard_charges":[{"gross_charge":328.35,"discounted_cash":328.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RANOLAZINE ER 500 MG PO TB12 [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-773-60","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76329-3321-0","type":"NDC"}],"standard_charges":[{"gross_charge":72.31,"discounted_cash":72.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-201-85","type":"NDC"}],"standard_charges":[{"gross_charge":70.57,"discounted_cash":70.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1401-05","type":"NDC"}],"standard_charges":[{"gross_charge":951.43,"discounted_cash":951.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN [91408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1401-01","type":"NDC"}],"standard_charges":[{"gross_charge":114.7,"discounted_cash":114.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"}]},{"description":"RAVULIZUMAB-CWVZ 300 MG/3ML IV SOLN [144141]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682-025-01","type":"NDC"}],"standard_charges":[{"gross_charge":24026.99,"discounted_cash":24026.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"RASBURICASE 1.5 MG IV SOLR [33591]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0024-5154-11","type":"NDC"}],"standard_charges":[{"gross_charge":10355.41,"discounted_cash":10355.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"RASAGILINE MESYLATE 1 MG PO TABS [76481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-690-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":22.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":45.59,"discounted_cash":45.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"RASAGILINE MESYLATE 1 MG PO TABS [76481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1271-93","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"RANOLAZINE ER 500 MG PO TB12 [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-722-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RANOLAZINE ER 500 MG PO TB12 [70434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45963-418-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"RAMUCIRUMAB 100 MG/10ML IV SOLN [125526]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"0002-7669-01","type":"NDC"}],"standard_charges":[{"gross_charge":4138.41,"discounted_cash":4138.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL [130447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-67","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPRANOLOL HCL 40 MG PO TABS [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5556-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 40 MG PO TABS [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0184-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 20 MG/5ML PO SOLN [6654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3727-63","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-2078-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 40 MG PO TABS [6658]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-2079-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL ER 80 MG PO CP24 [38225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2779-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL ER 60 MG PO CP24 [38224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-215-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":32.67,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL ER 60 MG PO CP24 [38224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-215-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":32.67,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 20 MG PO TABS [6657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5555-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5554-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 1 MG/ML IV SOLN [29335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-604-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROPRANOLOL HCL 1 MG/ML IV SOLN [29335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-604-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROPOFOL 500 MG/50ML IV RATE BASED FOR ANES [408130446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0409-4699-33","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL [130445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-94","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL [130445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-43","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL [130445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323-269-22","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL [130445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0641-6194-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL [130445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0409-4699-50","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL [130445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"0409-4699-30","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PROPRANOLOL HCL ER 80 MG PO CP24 [38225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-4117-37","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5482-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-2077-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PROPRANOLOL HCL 10 MG PO TABS [6656]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6550-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR [11240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-220-03","type":"NDC"}],"standard_charges":[{"gross_charge":33.44,"discounted_cash":33.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":66.88,"discounted_cash":66.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG PO TABS [11239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-494-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG PO TABS [11239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-502-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG PO TABS [11239]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-3511-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN [127803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3040-95","type":"NDC"}],"standard_charges":[{"gross_charge":175.84,"discounted_cash":175.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN [127803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-3040-72","type":"NDC"}],"standard_charges":[{"gross_charge":194.04,"discounted_cash":194.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PYRETH-PIP BUTOX-PERMETH-NITRE CO KIT [33476]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63736-027-06","type":"NDC"}],"standard_charges":[{"gross_charge":19.82,"discounted_cash":19.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PYRAZINAMIDE 500 MG PO TABS [6738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-484-30","type":"NDC"}],"standard_charges":[{"gross_charge":50.33,"discounted_cash":50.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":25.17,"discounted_cash":25.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PURIFIED WATER PO LIQD [24068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"38779-0946-8","type":"NDC"}],"standard_charges":[{"gross_charge":441.0,"discounted_cash":441.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR [11240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-301-30","type":"NDC"}],"standard_charges":[{"gross_charge":123.65,"discounted_cash":123.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":247.29,"discounted_cash":247.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"PYRIDOXINE HCL 100 MG/ML IJ SOLN [6744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-180-00","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":75.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":189.36,"discounted_cash":189.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-904-18","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"QUETIAPINE FUMARATE 100 MG PO TABS [21824]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-147-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"PYRIMETHAMINE 25 MG PO TABS [11246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69413-330-30","type":"NDC"}],"standard_charges":[{"gross_charge":4815.0,"discounted_cash":4815.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PYRIMETHAMINE 25 MG PO TABS [11246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0480-3720-56","type":"NDC"}],"standard_charges":[{"gross_charge":818.27,"discounted_cash":818.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"PYRIDOXINE HCL 100 MG/ML IJ SOLN [6744]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-180-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.21,"discounted_cash":75.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":188.01,"discounted_cash":188.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PSYLLIUM 95 % PO PACK [24788]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"38485-80857","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PSYLLIUM 51.7 % PO PACK [133686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000-024-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-229-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":55.9,"discounted_cash":55.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-229-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":43.7,"discounted_cash":43.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROSOL 20 % IV SOLN [30253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0499-06","type":"NDC"}],"standard_charges":[{"gross_charge":637.0,"discounted_cash":637.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"PROPYLTHIOURACIL 50 MG PO TABS [6662]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-964-95","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPYLTHIOURACIL 5 MG/ML PO SUSP [4082006663]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-964-95","type":"NDC"}],"standard_charges":[{"gross_charge":28.7,"discounted_cash":28.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":57.4,"discounted_cash":57.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":86.1,"discounted_cash":86.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":14.35,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PROPRANOLOL HCL ER 80 MG PO CP24 [38225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-226-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PSYLLIUM 51.7 % PO PACK [133686]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000-25445","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN [6677]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-229-95","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":43.7,"discounted_cash":43.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PSYLLIUM 25 % PO PACK [153201]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"37000-74087","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PACKET"}]},{"description":"PSEUDOEPHEDRINE HCL 60 MG PO TABS [6715]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6728-46","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PSEUDOEPHEDRINE HCL 30 MG PO TABS [6714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5053-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PRUCALOPRIDE SUCCINATE 2 MG PO TABS [139097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-597-10","type":"NDC"}],"standard_charges":[{"gross_charge":2889.9,"discounted_cash":2889.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"PRUCALOPRIDE SUCCINATE 2 MG PO TABS [139097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-547-01","type":"NDC"}],"standard_charges":[{"gross_charge":3569.09,"discounted_cash":3569.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"PROTRIPTYLINE HCL 5 MG PO TABS [11164]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-004-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT [122245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-396-01","type":"NDC"}],"standard_charges":[{"gross_charge":4556.45,"discounted_cash":4556.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT [122245]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-386-02","type":"NDC"}],"standard_charges":[{"gross_charge":4556.45,"discounted_cash":4556.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT [125248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-397-01","type":"NDC"}],"standard_charges":[{"gross_charge":8636.63,"discounted_cash":8636.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS IV KIT [125248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63833-387-02","type":"NDC"}],"standard_charges":[{"gross_charge":8636.63,"discounted_cash":8636.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SORBITOL 70 % N/A SOLN [93927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"46287-500-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SORBITOL 70 % N/A SOLN [93927]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"92771-700-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SOTALOL HCL 150 MG/10ML IV SOLN [103935]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69724-112-10","type":"NDC"}],"standard_charges":[{"gross_charge":13593.14,"discounted_cash":13593.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"VALSARTAN 80 MG PO TABS [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-361-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 80 MG PO TABS [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-732-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 40 MG PO TABS [33541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-415-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALSARTAN 160 MG PO TABS [31210]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-362-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VALPROIC ACID 250 MG/5ML PO SOLN [107838]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4675-40","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALSARTAN 80 MG PO TABS [31209]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-045-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VANCOMYCIN HCL 1 G/10ML IJ (WET SOLR VIAL) [40888138031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-105-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 1 G/10ML IJ (WET SOLR VIAL) [40888138031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-284-42","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 1 G/10ML IJ (WET SOLR VIAL) [40888138031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALGANCICLOVIR HCL 50 MG/ML PO SOLR [99443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0004-0039-09","type":"NDC"}],"standard_charges":[{"gross_charge":3724.96,"discounted_cash":3724.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88 ML"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-753-60","type":"NDC"}],"standard_charges":[{"gross_charge":19.91,"discounted_cash":19.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":39.81,"discounted_cash":39.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"URSODIOL 300 MG PO CAPS [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-100-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.81,"discounted_cash":30.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG PO CAPS [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG PO CAPS [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-383-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG PO CAPS [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-383-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG PO CAPS [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7168-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 300 MG PO CAPS [11624]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3159-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"URSODIOL 250 MG PO TABS [22660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-473-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"URIBEL 118 MG PO CAPS [105471]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0178-0740-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 MG"}]},{"description":"UREA 15 G PO PACK [133112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62530-00011","type":"NDC"}],"standard_charges":[{"gross_charge":25.61,"discounted_cash":25.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"},{"gross_charge":51.21,"discounted_cash":51.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"},{"gross_charge":76.81,"discounted_cash":76.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"},{"gross_charge":102.41,"discounted_cash":102.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"UMECLIDINIUM-VILANTEROL 62.5-25 MCG/ACT IN AEPB [149307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0869-10","type":"NDC"}],"standard_charges":[{"gross_charge":1526.76,"discounted_cash":1526.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 EACH"}]},{"description":"UMECLIDINIUM-VILANTEROL 62.5-25 MCG/ACT IN AEPB [149307]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0869-06","type":"NDC"}],"standard_charges":[{"gross_charge":395.39,"discounted_cash":395.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 EACH"}]},{"description":"URSODIOL 50 MG/ML PO SUSP [40840056]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-343-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN HCL 10 G IV SOLR [11627]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-314-61","type":"NDC"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 MG"}]},{"description":"USTEKINUMAB 45 MG/0.5ML SC SOLN [99447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3357","type":"HCPCS"},{"code":"57894-060-02","type":"NDC"}],"standard_charges":[{"gross_charge":30344.52,"discounted_cash":30344.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":60689.04,"discounted_cash":60689.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"USTEKINUMAB 90 MG/ML SC SOSY [125375]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3357","type":"HCPCS"},{"code":"57894-061-03","type":"NDC"}],"standard_charges":[{"gross_charge":46055.36,"discounted_cash":46055.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-762-60","type":"NDC"}],"standard_charges":[{"gross_charge":138.52,"discounted_cash":138.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":277.04,"discounted_cash":277.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-973-60","type":"NDC"}],"standard_charges":[{"gross_charge":19.93,"discounted_cash":19.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":39.86,"discounted_cash":39.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-158-60","type":"NDC"}],"standard_charges":[{"gross_charge":24.65,"discounted_cash":24.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":49.29,"discounted_cash":49.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-6330-20","type":"NDC"}],"standard_charges":[{"gross_charge":23.46,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":46.92,"discounted_cash":46.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"VALGANCICLOVIR HCL 450 MG PO TABS [30148]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0004-0038-22","type":"NDC"}],"standard_charges":[{"gross_charge":465.72,"discounted_cash":465.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"},{"gross_charge":931.44,"discounted_cash":931.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 MG"}]},{"description":"VALACYCLOVIR HCL 500 MG PO TABS [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-042-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VALACYCLOVIR HCL 500 MG PO TABS [13133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-704-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"UTI-STAT PO LIQD [91873]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"26974-41066","type":"NDC"}],"standard_charges":[{"gross_charge":170.31,"discounted_cash":170.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 887 ML"}]},{"description":"VANCOMYCIN HCL 1000 MG/200ML IV SOLN [139460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70594-042-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"VANCOMYCIN HCL 1000 MG/200ML IV SOLN [139460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70594-042-03","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"VANCOMYCIN HCL IVPB 1750 MG [4082000031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-314-31","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1750 MG"}]},{"description":"VANCOMYCIN HCL IVPB 1500 MG [4082000030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-314-30","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"}]},{"description":"VANCOMYCIN HCL IVPB 1250 MG [4082000029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-314-29","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"}]},{"description":"VANCOMYCIN HCL IN NACL 1-0.9 GM/200ML-% IV SOLN [131079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-314-66","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"VANCOMYCIN HCL IN DEXTROSE 1-5 GM/200ML-% IV SOLN [92895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-3552-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"VANCOMYCIN HCL 500 MG/5ML IJ (WET SOLR VIAL) [40888443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-104-41","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 500 MG/5ML IJ (WET SOLR VIAL) [40888443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-339-50","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 500 MG/5ML IJ (WET SOLR VIAL) [40888443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-339-00","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 500 MG/5ML IJ (WET SOLR VIAL) [40888443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-221-48","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 500 MG/5ML IJ (WET SOLR VIAL) [40888443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-221-43","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL IVPB 2000 MG [4082000032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-314-32","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"}]},{"description":"VANCOMYCIN HCL 500 MG/5ML IJ (WET SOLR VIAL) [40888443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-221-41","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL IVPB 2250 MG 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[127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023-164-83","type":"NDC"}],"standard_charges":[{"gross_charge":91.27,"discounted_cash":91.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-164-83","type":"NDC"}],"standard_charges":[{"gross_charge":91.27,"discounted_cash":91.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2599","type":"HCPCS"},{"code":"0517-1020-25","type":"NDC"}],"standard_charges":[{"gross_charge":84.13,"discounted_cash":84.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-1020-25","type":"NDC"}],"standard_charges":[{"gross_charge":84.13,"discounted_cash":84.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2599","type":"HCPCS"},{"code":"0517-1020-01","type":"NDC"}],"standard_charges":[{"gross_charge":449.37,"discounted_cash":449.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-1020-01","type":"NDC"}],"standard_charges":[{"gross_charge":449.37,"discounted_cash":449.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"VASOPRESSIN 0.4 UT/ML IV SOLN [400033]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-1020-25","type":"NDC"}],"standard_charges":[{"gross_charge":313.33,"discounted_cash":313.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML IJ SUSR [155023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-4827-00","type":"NDC"}],"standard_charges":[{"gross_charge":1141.37,"discounted_cash":1141.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VARENICLINE TARTRATE 1 MG PO TABS 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Pharmacy | NDC EA = 1 MG"}]},{"description":"VANCOMYCIN HCL 1 G/10ML IJ (WET SOLR VIAL) [40888138031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63323-284-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"VANCOMYCIN HCL IVPB 2500 MG [4082000034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-314-34","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2500 MG"}]},{"description":"UMECLIDINIUM BROMIDE 62.5 MCG/ACT IN AEPB 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[8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-221-33","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 500 MG IV SOLR [8443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-221-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VANCOMYCIN HCL 50 MG/ML PO SOLR [11630]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65628-206-05","type":"NDC"}],"standard_charges":[{"gross_charge":897.3,"discounted_cash":897.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"VANCOMYCIN HCL 5 G IV SOLR [138032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323-295-66","type":"NDC"}],"standard_charges":[{"gross_charge":170.35,"discounted_cash":170.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VANCOMYCIN HCL 125 MG/2.5 ML PO SOLN [4081130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-2015-5","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-166-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-166-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42494-450-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN HCL 125 MG PO CAPS [11628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0867-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"VANCOMYCIN HCL 500 MG RE ENEM [400467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-9999-93","type":"NDC"}],"standard_charges":[{"gross_charge":30.24,"discounted_cash":30.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-914-25","type":"NDC"}],"standard_charges":[{"gross_charge":127.78,"discounted_cash":127.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"UMECLIDINIUM BROMIDE 62.5 MCG/ACT IN AEPB [149262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0873-06","type":"NDC"}],"standard_charges":[{"gross_charge":244.65,"discounted_cash":244.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 EACH"}]},{"description":"TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999-1094-1","type":"NDC"}],"standard_charges":[{"gross_charge":79.77,"discounted_cash":79.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRAZODONE HCL 50 MG PO TABS [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-079-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAVOPROST (BAK FREE) 0.004 % OP SOLN [113154]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0593-4","type":"NDC"}],"standard_charges":[{"gross_charge":415.64,"discounted_cash":415.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"TRASTUZUMAB-QYYP 420 MG IV SOLR [142036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"Q5116","type":"HCPCS"},{"code":"0069-0306-01","type":"NDC"}],"standard_charges":[{"gross_charge":6235.99,"discounted_cash":6235.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-QYYP 420 MG IV SOLR [142036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"Q5116","type":"HCPCS"},{"code":"0069-0305-01","type":"NDC"}],"standard_charges":[{"gross_charge":35426.76,"discounted_cash":35426.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-HYALURONIDASE-OYSK 600-10000 MG-UNT/5ML SC SOLN 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[142746]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5112","type":"HCPCS"},{"code":"78206-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":4451.87,"discounted_cash":4451.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR [141175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"83257-003-11","type":"NDC"}],"standard_charges":[{"gross_charge":8674.84,"discounted_cash":8674.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR [141175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"67457-845-50","type":"NDC"}],"standard_charges":[{"gross_charge":8674.84,"discounted_cash":8674.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-DKST 150 MG IV SOLR [141179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"83257-001-11","type":"NDC"}],"standard_charges":[{"gross_charge":5445.98,"discounted_cash":5445.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB-ANNS 420 MG IV SOLR [140387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5117","type":"HCPCS"},{"code":"55513-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":13905.45,"discounted_cash":13905.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRASTUZUMAB 150 MG IV SOLR [135738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9355","type":"HCPCS"},{"code":"50242-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":5880.29,"discounted_cash":5880.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRANEXAMIC ACID 650 MG PO TABS [104576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69918-301-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1300 MG"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR [141175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5114","type":"HCPCS"},{"code":"83257-004-12","type":"NDC"}],"standard_charges":[{"gross_charge":8674.84,"discounted_cash":8674.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRAZODONE HCL 50 MG PO TABS [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-014-72","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE HCL 50 MG PO TABS [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-560-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE HCL 50 MG PO TABS [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-560-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRANEXAMIC ACID 650 MG PO TABS [104576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-265-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1300 MG"}]},{"description":"TRANEXAMIC ACID 650 MG PO TABS [104576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3720-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1300 MG"}]},{"description":"TRANEXAMIC ACID 5 % MT SOLN [127751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-2050-1","type":"NDC"}],"standard_charges":[{"gross_charge":25.98,"discounted_cash":25.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN [130439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-510-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-808-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-795-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-795-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60219-2348-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-377-08","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-991-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAZODONE HCL 50 MG PO TABS [8085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-805-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-808-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN [130439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-510-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN [130439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-107-10","type":"NDC"}],"standard_charges":[{"gross_charge":45.94,"discounted_cash":45.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":45.94,"discounted_cash":45.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN [130439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72485-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IV SOLN [130439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IN SOLN [4082130439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0960-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.41,"discounted_cash":22.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"TRANEXAMIC ACID 1000 MG/10ML IN SOLN [4082130439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-0960-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"TRANDOLAPRIL 2 MG PO TABS [17018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-567-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TRIHEXYPHENIDYL HCL 2 MG PO TABS [8166]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-212-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIHEXYPHENIDYL HCL 2 MG PO TABS [8166]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5335-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIFLUOPERAZINE HCL 2 MG PO TABS [8163]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-8032-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIAZOLAM 0.125 MG PO TABS [8138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1521-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"TRIAZOLAM 0.125 MG PO TABS [8138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4858-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"TRIAMTERENE-HCTZ 75-50 MG PO TABS [8134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-857-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRIAMTERENE-HCTZ 75-50 MG PO TABS [8134]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2657-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"TRIMETHOBENZAMIDE HCL 100 MG/ML IM SOLN [8178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023-119-25","type":"NDC"}],"standard_charges":[{"gross_charge":354.79,"discounted_cash":354.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TRIMETHOBENZAMIDE HCL 300 MG PO CAPS [32311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-376-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-752-78","type":"NDC"}],"standard_charges":[{"gross_charge":57.27,"discounted_cash":57.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN [8259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-104-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"TRYPAN BLUE 0.06 % IO SOSY [149042]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68803-612-10","type":"NDC"}],"standard_charges":[{"gross_charge":475.73,"discounted_cash":475.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TROSPIUM CHLORIDE ER 60 MG PO CP24 [89385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-174-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"TROSPIUM CHLORIDE ER 60 MG PO CP24 [89385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-427-04","type":"NDC"}],"standard_charges":[{"gross_charge":25.45,"discounted_cash":25.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"TROSPIUM CHLORIDE 20 MG PO TABS [38977]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-912-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TROPIC-CYCLOP-PE-KETO-PROPAR OP SOSY [143832]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71266-8221-1","type":"NDC"}],"standard_charges":[{"gross_charge":45.97,"discounted_cash":45.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TROPIC-CYCLOPENT-PE-KETOROLAC 1-1-2.5-0.5 % OP SOLN [143820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71266-8240-5","type":"NDC"}],"standard_charges":[{"gross_charge":344.76,"discounted_cash":344.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TROPIC-CYCLOPENT-PE-KETOROLAC 1-1-2.5-0.5 % OP SOLN [143820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71266-8240-1","type":"NDC"}],"standard_charges":[{"gross_charge":40.64,"discounted_cash":40.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TROPICAMIDE 1 % OP SOLN [8250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-121-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.56,"discounted_cash":34.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN [8250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-355-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.52,"discounted_cash":47.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"TROPICAMIDE 0.5 % OP SOLN [8249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.26,"discounted_cash":19.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TROPICAMIDE 0.5 % OP SOLN [8249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-101-12","type":"NDC"}],"standard_charges":[{"gross_charge":24.75,"discounted_cash":24.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TROPHAMINE 10 % IV SOLN [25798]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-9341-55","type":"NDC"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":274.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"TRIMETHOPRIM 100 MG PO TABS [8182]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-541-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRIMETHOBENZAMIDE HCL 300 MG PO CAPS [32311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-660-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOSY [147739]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"49281-790-51","type":"NDC"}],"standard_charges":[{"gross_charge":753.93,"discounted_cash":753.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TRIAMTERENE-HCTZ 37.5-25 MG PO TABS [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-327-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMTERENE 50 MG PO CAPS [11588]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59212-002-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.68,"discounted_cash":66.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.147 MG/GM EX AERS [19770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-045-01","type":"NDC"}],"standard_charges":[{"gross_charge":400.68,"discounted_cash":400.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 63 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.147 MG/GM EX AERS [19770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"10631-093-62","type":"NDC"}],"standard_charges":[{"gross_charge":3223.97,"discounted_cash":3223.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 63 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE [8121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-1267-5","type":"NDC"}],"standard_charges":[{"gross_charge":120.63,"discounted_cash":120.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"52565-014-26","type":"NDC"}],"standard_charges":[{"gross_charge":84.49,"discounted_cash":84.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-1284-2","type":"NDC"}],"standard_charges":[{"gross_charge":29.6,"discounted_cash":29.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT [8118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-055-35","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA [8113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67877-251-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA [8113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-064-35","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA [8113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-064-05","type":"NDC"}],"standard_charges":[{"gross_charge":73.55,"discounted_cash":73.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 454 G"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA [8113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0168-0004-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TRETINOIN 10 MG PO CAPS [16005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-075-11","type":"NDC"}],"standard_charges":[{"gross_charge":123.6,"discounted_cash":123.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRETINOIN 10 MG PO CAPS [16005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10370-268-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.06,"discounted_cash":39.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TRETINOIN 10 MG PO CAPS [16005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0808-02","type":"NDC"}],"standard_charges":[{"gross_charge":90.07,"discounted_cash":90.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN [149765]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9347","type":"HCPCS"},{"code":"0310-4535-30","type":"NDC"}],"standard_charges":[{"gross_charge":141956.7,"discounted_cash":141956.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP [11584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-0494-20","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":96.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":96.52,"discounted_cash":96.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":96.52,"discounted_cash":96.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TRIAMTERENE-HCTZ 37.5-25 MG PO TABS [8132]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-2656-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"TRIAMCINOLONE ACETONIDE 32 MG IX SRER [133821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3304","type":"HCPCS"},{"code":"70801-003-01","type":"NDC"}],"standard_charges":[{"gross_charge":3684.4,"discounted_cash":3684.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP [89128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3300","type":"HCPCS"},{"code":"9999-3004-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP [89128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-3004-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP [89128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3300","type":"HCPCS"},{"code":"0065-0543-01","type":"NDC"}],"standard_charges":[{"gross_charge":296.42,"discounted_cash":296.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP [89128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0065-0543-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.81,"discounted_cash":98.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":197.62,"discounted_cash":197.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71283-0635-2","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":44.08,"discounted_cash":44.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":58.77,"discounted_cash":58.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70121-1168-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP [8120]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-0241-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.15,"discounted_cash":61.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":91.72,"discounted_cash":91.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":122.29,"discounted_cash":122.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"43598-914-25","type":"NDC"}],"standard_charges":[{"gross_charge":127.78,"discounted_cash":127.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"63323-930-00","type":"NDC"}],"standard_charges":[{"gross_charge":132.54,"discounted_cash":132.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"ZAFIRLUKAST 20 MG PO TABS [17960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-554-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZAFIRLUKAST 20 MG PO TABS [17960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-008-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"XENON XE 133 10 MCI IN GAS [133933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"11994-127-10","type":"NDC"}],"standard_charges":[{"gross_charge":1227.64,"discounted_cash":1227.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"WONDER GARGLE [4081127]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-1063-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"WITCH HAZEL-GLYCERIN EX PADS [11678]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41388-007-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 PAD"}]},{"description":"WARFARIN SODIUM 7.5 MG PO TABS [8752]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1218-89","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 5 MG PO TABS [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-994-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 5 MG PO TABS [8751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1216-89","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZAFIRLUKAST 20 MG PO TABS [17960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-626-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZANAMIVIR 200 MG/20 ML INJECTION [4084232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"99999302210","type":"NDC"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ZINC SULFATE 220 (50 ZN) MG PO CAPS WR [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-983-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 220 MG"}]},{"description":"ZINC SULFATE 220 (50 ZN) MG PO CAPS WR [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-983-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 220 MG"}]},{"description":"ZINC SULFATE 220 (50 ZN) MG PO CAPS WR [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555-04000","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 220 MG"}]},{"description":"ZINC OXIDE 20 % EX OINT [8874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75834-170-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"ZINC OXIDE 20 % EX OINT [8874]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-676-46","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"ZINC OXIDE 16 % EX OINT [109467]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62103-0333-2","type":"NDC"}],"standard_charges":[{"gross_charge":6.14,"discounted_cash":6.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"ZINC OXIDE 12.8 % EX OINT [42682]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16864-02101","type":"NDC"}],"standard_charges":[{"gross_charge":8.67,"discounted_cash":8.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"ZINC CHLORIDE 1 MG/ML IV SOLN [8865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"51754-0102-4","type":"NDC"}],"standard_charges":[{"gross_charge":109.0,"discounted_cash":109.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZINC CHLORIDE 1 MG/ML IV SOLN [8865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"0409-4090-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.94,"discounted_cash":117.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ZIDOVUDINE 100 MG PO CAPS [11692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-107-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"ZIDOVUDINE 10 MG/ML PO SYRP [11693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-048-24","type":"NDC"}],"standard_charges":[{"gross_charge":197.28,"discounted_cash":197.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":197.28,"discounted_cash":197.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ZANAMIVIR 5 MG/ACT IN AEPB [149193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0681-01","type":"NDC"}],"standard_charges":[{"gross_charge":355.56,"discounted_cash":355.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PUFF"},{"gross_charge":355.56,"discounted_cash":355.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 PUFF"}]},{"description":"WARFARIN SODIUM 3 MG PO TABS [19433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1214-89","type":"NDC"}],"standard_charges":[{"gross_charge":40.84,"discounted_cash":40.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 2 MG PO TABS [8749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1212-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 10 MG PO TABS [8748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1219-89","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 1 MG PO TABS [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-761-10","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 1 MG PO TABS [11664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1211-89","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"VORTIOXETINE HBR 5 MG PO TABS [123984]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-720-30","type":"NDC"}],"standard_charges":[{"gross_charge":202.68,"discounted_cash":202.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":405.36,"discounted_cash":405.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":101.34,"discounted_cash":101.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 2 MG PO TABS [8749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1212-89","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZINC SULFATE 220 (50 ZN) MG PO CAPS WR [4088880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681-13500","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 220 MG"}]},{"description":"WARFARIN SODIUM 2 MG PO TABS [8749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 2.5 MG PO TABS [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-027-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 2.5 MG PO TABS [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-027-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 2.5 MG PO TABS [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1213-89","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"WARFARIN SODIUM 2.5 MG PO TABS [8750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-1213-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZIPRASIDONE 2.5 MG/ML PO SOLN [40833175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-848-99","type":"NDC"}],"standard_charges":[{"gross_charge":51.64,"discounted_cash":51.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":103.28,"discounted_cash":103.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZIPRASIDONE HCL 20 MG PO CAPS [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2164-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-838-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-838-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6082-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5317-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0073-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLMITRIPTAN 5 MG PO TABS [22219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-250-18","type":"NDC"}],"standard_charges":[{"gross_charge":13.12,"discounted_cash":13.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":26.23,"discounted_cash":26.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":52.46,"discounted_cash":52.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZONISAMIDE 25 MG PO CAPS [36987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 25 MG PO CAPS [36987]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-242-00","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ZONISAMIDE 100 MG/5ML PO SUSP [149054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52652-8001-1","type":"NDC"}],"standard_charges":[{"gross_charge":2480.4,"discounted_cash":2480.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"ZONISAMIDE 100 MG PO CAPS [27780]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-861-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-189-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLPIDEM TARTRATE 5 MG PO TABS [11701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-189-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"VORTIOXETINE HBR 20 MG PO TABS [123986]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-750-30","type":"NDC"}],"standard_charges":[{"gross_charge":50.67,"discounted_cash":50.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":101.34,"discounted_cash":101.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":25.34,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLMITRIPTAN 5 MG PO TABS [22219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-022-38","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZIPRASIDONE HCL 80 MG PO CAPS [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-259-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE HCL 80 MG PO CAPS [29781]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2168-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE HCL 20 MG PO CAPS [29778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-256-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR [33175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-848-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":44.19,"discounted_cash":44.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR [33175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-848-58","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":80.97,"discounted_cash":80.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"ZOLMITRIPTAN 5 MG NA SOLN [37083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69238-2007-6","type":"NDC"}],"standard_charges":[{"gross_charge":516.37,"discounted_cash":516.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ZOLMITRIPTAN 5 MG NA SOLN [37083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64896-681-51","type":"NDC"}],"standard_charges":[{"gross_charge":584.33,"discounted_cash":584.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ZOLMITRIPTAN 5 MG NA SOLN [37083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-711-91","type":"NDC"}],"standard_charges":[{"gross_charge":228.6,"discounted_cash":228.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ZOLMITRIPTAN 5 MG NA SOLN [37083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-711-00","type":"NDC"}],"standard_charges":[{"gross_charge":443.82,"discounted_cash":443.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SPRAY"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-806-51","type":"NDC"}],"standard_charges":[{"gross_charge":383.8,"discounted_cash":383.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-619-10","type":"NDC"}],"standard_charges":[{"gross_charge":264.4,"discounted_cash":264.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN [81434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"51991-064-98","type":"NDC"}],"standard_charges":[{"gross_charge":793.6,"discounted_cash":793.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68001-610-25","type":"NDC"}],"standard_charges":[{"gross_charge":172.99,"discounted_cash":172.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68001-437-25","type":"NDC"}],"standard_charges":[{"gross_charge":272.69,"discounted_cash":272.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-233-11","type":"NDC"}],"standard_charges":[{"gross_charge":61.6,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-170-31","type":"NDC"}],"standard_charges":[{"gross_charge":78.79,"discounted_cash":78.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-4215-05","type":"NDC"}],"standard_charges":[{"gross_charge":65.38,"discounted_cash":65.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG IM SOLR [33175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.12,"discounted_cash":62.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":124.23,"discounted_cash":124.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-930-00","type":"NDC"}],"standard_charges":[{"gross_charge":132.54,"discounted_cash":132.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"VORTIOXETINE HBR 10 MG PO TABS [123985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64764-730-30","type":"NDC"}],"standard_charges":[{"gross_charge":101.34,"discounted_cash":101.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":202.68,"discounted_cash":202.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":50.67,"discounted_cash":50.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"VERAPAMIL HCL 120 MG PO TABS [8528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-0345-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CP24 [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1699-9","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CP24 [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-035-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CP24 [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-528-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE HCL ER 75 MG PO CP24 [27858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-528-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE HCL ER 37.5 MG PO CP24 [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-034-16","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VERAPAMIL HCL 120 MG PO TABS [8528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2924-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VERAPAMIL HCL 2.5 MG/ML IV SOLN [8527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70710-1643-7","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"VERAPAMIL HCL ER 120 MG PO TBCR [13184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-292-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL HCL ER 120 MG PO CP24 [25238]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2880-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"}]},{"description":"VERAPAMIL HCL ER 100 MG PO CP24 [88029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-485-37","type":"NDC"}],"standard_charges":[{"gross_charge":22.58,"discounted_cash":22.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":45.16,"discounted_cash":45.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":45.16,"discounted_cash":45.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":67.74,"discounted_cash":67.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VERAPAMIL HCL 80 MG PO TABS [8530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-026-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"VENLAFAXINE HCL ER 37.5 MG PO CP24 [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-527-90","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE HCL 37.5 MG PO TABS [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-393-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENETOCLAX 100 MG PO TABS [131006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-0576-11","type":"NDC"}],"standard_charges":[{"gross_charge":739.65,"discounted_cash":739.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":147.93,"discounted_cash":147.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":1479.3,"discounted_cash":1479.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2958.6,"discounted_cash":2958.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":369.83,"discounted_cash":369.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-781-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.71,"discounted_cash":50.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-235-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-235-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.37,"discounted_cash":47.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR [11634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1632-21","type":"NDC"}],"standard_charges":[{"gross_charge":50.4,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"63323-930-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.27,"discounted_cash":88.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN [127126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-930-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.27,"discounted_cash":88.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"VENLAFAXINE HCL 37.5 MG PO TABS [12207]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-158-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VERAPAMIL HCL ER 180 MG PO TBCR [14626]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VENLAFAXINE HCL ER 37.5 MG PO CP24 [27857]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-527-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE HCL ER 150 MG PO CP24 [27859]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-045-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VENLAFAXINE HCL 50 MG PO TABS [12204]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-394-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"VERAPAMIL HCL ER 240 MG PO TBCR [13073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1411-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VITAMINS A & D EX OINT [8723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-40663","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56.7 G"}]},{"description":"VITAMINS A & D EX OINT [8723]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-0122-4","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN [8718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"0409-9158-31","type":"NDC"}],"standard_charges":[{"gross_charge":302.54,"discounted_cash":302.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN [8718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-9158-31","type":"NDC"}],"standard_charges":[{"gross_charge":60.51,"discounted_cash":60.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":151.27,"discounted_cash":151.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"VITAMIN E 180 MG (400 UNIT) PO CAPS [145404]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"77333-951-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 UNITS"}]},{"description":"VITAMIN D3 25 MCG (1000 UT) PO TABS [76997]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681-16900","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 UNITS"}]},{"description":"VITAMIN D 10 MCG/ML PO LIQD [141076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-917-50","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VITAMIN D 10 MCG/ML PO LIQD [141076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1343-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS [100493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-500-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":3.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"VITAMINS/MINERALS PO TABS [8722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-4661-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS [100493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-297-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":3.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"VITAMINS/MINERALS PO TABS [8722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"40985-22368","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"VORICONAZOLE 200 MG PO TABS [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0049-3180-30","type":"NDC"}],"standard_charges":[{"gross_charge":567.86,"discounted_cash":567.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":567.86,"discounted_cash":567.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 40 MG/ML PO SUSR [38103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0049-3160-44","type":"NDC"}],"standard_charges":[{"gross_charge":100.34,"discounted_cash":100.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":200.67,"discounted_cash":200.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":301.01,"discounted_cash":301.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"VORICONAZOLE 200 MG PO TABS [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65862-892-30","type":"NDC"}],"standard_charges":[{"gross_charge":20.95,"discounted_cash":20.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":41.9,"discounted_cash":41.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG PO TABS [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-273-21","type":"NDC"}],"standard_charges":[{"gross_charge":111.71,"discounted_cash":111.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":111.71,"discounted_cash":111.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG PO TABS [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-273-11","type":"NDC"}],"standard_charges":[{"gross_charge":120.83,"discounted_cash":120.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":120.83,"discounted_cash":120.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG PO TABS [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51079-165-03","type":"NDC"}],"standard_charges":[{"gross_charge":83.3,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":83.3,"discounted_cash":83.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VORICONAZOLE 200 MG PO TABS [33009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-7024-04","type":"NDC"}],"standard_charges":[{"gross_charge":34.09,"discounted_cash":34.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":68.17,"discounted_cash":68.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS [100493]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-297-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":3.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50000 UNITS"}]},{"description":"VITAMIN C 500 MG PO TABS [8680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-841-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"VILAZODONE HCL 20 MG PO TABS [109403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-233-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"VILAZODONE HCL 20 MG PO TABS [109403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4773-3","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"VILAZODONE HCL 20 MG PO TABS [109403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1120-30","type":"NDC"}],"standard_charges":[{"gross_charge":71.88,"discounted_cash":71.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":71.88,"discounted_cash":71.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":143.75,"discounted_cash":143.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"VERICIGUAT 2.5 MG PO TABS [144867]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-5028-02","type":"NDC"}],"standard_charges":[{"gross_charge":546.56,"discounted_cash":546.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":136.64,"discounted_cash":136.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":273.28,"discounted_cash":273.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"VERAPAMIL HCL ER 240 MG PO TBCR [13073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 MG"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN [8597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-4412-11","type":"NDC"}],"standard_charges":[{"gross_charge":225.89,"discounted_cash":225.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"VITAMIN B6 50 MG PO TABS [139398]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10006-70012","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"VITAMIN B-12 500 MCG PO TABS [8657]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681-12800","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MCG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"VITAMIN A 3 MG (10000 UT) PO CAPS [142490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"87701-40725","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"VITAMIN A 3 MG (10000 UT) PO CAPS [142490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-2085-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10000 UNITS"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"VINCRISTINE SULFATE 2 MG/2ML IV SOLN [154713]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-309-16","type":"NDC"}],"standard_charges":[{"gross_charge":129.9,"discounted_cash":129.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN [8597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-309-06","type":"NDC"}],"standard_charges":[{"gross_charge":242.12,"discounted_cash":242.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN [8597]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-4402-11","type":"NDC"}],"standard_charges":[{"gross_charge":209.26,"discounted_cash":209.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP [6487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"11980-180-05","type":"NDC"}],"standard_charges":[{"gross_charge":813.03,"discounted_cash":813.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-991-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TAMSULOSIN HCL 0.4 MG PO CAPS [103890]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-132-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 MG"}]},{"description":"TAMOXIFEN CITRATE 10 MG PO TABS [7711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-269-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAMOXIFEN CITRATE 10 MG PO TABS [7711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59651-299-60","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"TAPENTADOL HCL 50 MG PO TABS [98253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-050-10","type":"NDC"}],"standard_charges":[{"gross_charge":143.96,"discounted_cash":143.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":71.98,"discounted_cash":71.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":107.97,"discounted_cash":107.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"TALC 5 G PL SUSR [37812]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63256-200-05","type":"NDC"}],"standard_charges":[{"gross_charge":686.26,"discounted_cash":686.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TALC 4 G PL POWD [136891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-444-04","type":"NDC"}],"standard_charges":[{"gross_charge":898.8,"discounted_cash":898.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"TADALAFIL 5 MG PO TABS [37400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-575-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TADALAFIL 5 MG PO TABS [37400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-644-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TALC 4 G PL POWD [136891]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62327-444-44","type":"NDC"}],"standard_charges":[{"gross_charge":1091.4,"discounted_cash":1091.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"TAPENTADOL HCL ER 50 MG PO TB12 [110262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24510-058-60","type":"NDC"}],"standard_charges":[{"gross_charge":150.66,"discounted_cash":150.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":225.99,"discounted_cash":225.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":301.32,"discounted_cash":301.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":376.65,"discounted_cash":376.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":75.33,"discounted_cash":75.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TECHNETIUM TC 99M MEBROFENIN IV KIT [103948]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"45567-0455-1","type":"NDC"}],"standard_charges":[{"gross_charge":186.44,"discounted_cash":186.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":169.49,"discounted_cash":169.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M LABELED RED BLOOD CELLS [4089921]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999102110","type":"NDC"}],"standard_charges":[{"gross_charge":1332.03,"discounted_cash":1332.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":666.02,"discounted_cash":666.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M HEXAMETHYLPROPYLENE AMINE OXIME [4089909]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999100910","type":"NDC"}],"standard_charges":[{"gross_charge":5489.17,"discounted_cash":5489.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M FILTERED SULFUR COLLOID [4089906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999100610","type":"NDC"}],"standard_charges":[{"gross_charge":3287.88,"discounted_cash":3287.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M EXAMETAZIME IV KIT [4089901]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"9999-1001-10","type":"NDC"}],"standard_charges":[{"gross_charge":4859.14,"discounted_cash":4859.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":4859.14,"discounted_cash":4859.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M BICISATE IV KIT [134043]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"11994-004-01","type":"NDC"}],"standard_charges":[{"gross_charge":7100.52,"discounted_cash":7100.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M AGGREGATED ALBUMIN EMERGENCY KIT [40819924]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"65174-270-30","type":"NDC"}],"standard_charges":[{"gross_charge":1175.96,"discounted_cash":1175.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TAZAROTENE 0.1 % EX CREA [29069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-1373-3","type":"NDC"}],"standard_charges":[{"gross_charge":621.36,"discounted_cash":621.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"TADALAFIL 5 MG PO TABS [37400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0480-2309-56","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS ER 1 MG PO CP24 [143528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0469-0677-73","type":"NDC"}],"standard_charges":[{"gross_charge":17.08,"discounted_cash":17.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"TACROLIMUS ER 0.75 MG PO TB24 [143529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7503","type":"HCPCS"},{"code":"68992-3075-1","type":"NDC"}],"standard_charges":[{"gross_charge":140.39,"discounted_cash":140.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TACROLIMUS ER 0.75 MG PO TB24 [143529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68992-3075-1","type":"NDC"}],"standard_charges":[{"gross_charge":26.33,"discounted_cash":26.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"},{"gross_charge":35.1,"discounted_cash":35.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"TACROLIMUS 5 MG/ML IV SOLN [12935]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0469-3016-01","type":"NDC"}],"standard_charges":[{"gross_charge":1613.17,"discounted_cash":1613.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TACROLIMUS 5 MG/10 ML DILUTION [40890076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-3016-01","type":"NDC"}],"standard_charges":[{"gross_charge":1588.2,"discounted_cash":1588.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TACROLIMUS 1 MG PO CAPS [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55111-526-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 1 MG PO CAPS [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"16729-042-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 1 MG PO CAPS [12933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-2103-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS ER 1 MG PO CP24 [143528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7508","type":"HCPCS"},{"code":"0469-0677-73","type":"NDC"}],"standard_charges":[{"gross_charge":34.16,"discounted_cash":34.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":170.79,"discounted_cash":170.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS ER 1 MG PO TB24 [143527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68992-3010-1","type":"NDC"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":26.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"},{"gross_charge":35.53,"discounted_cash":35.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"TADALAFIL 20 MG PO TABS [36986]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-739-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TADALAFIL 20 MG PO TABS [36986]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-739-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TADALAFIL (PAH) 20 MG PO TABS [97913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66302-467-60","type":"NDC"}],"standard_charges":[{"gross_charge":415.41,"discounted_cash":415.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TADALAFIL (PAH) 20 MG PO TABS [97913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-880-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TADALAFIL (PAH) 20 MG PO TABS [97913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-647-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TADALAFIL (PAH) 20 MG PO TABS [97913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-123-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TADALAFIL (PAH) 20 MG PO TABS [97913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6976-91","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TACROLIMUS ER 4 MG PO TB24 [143530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7503","type":"HCPCS"},{"code":"68992-3040-3","type":"NDC"}],"standard_charges":[{"gross_charge":142.11,"discounted_cash":142.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TACROLIMUS ER 4 MG PO TB24 [143530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68992-3040-3","type":"NDC"}],"standard_charges":[{"gross_charge":26.65,"discounted_cash":26.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"},{"gross_charge":35.53,"discounted_cash":35.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"TACROLIMUS ER 1 MG PO TB24 [143527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7503","type":"HCPCS"},{"code":"68992-3010-1","type":"NDC"}],"standard_charges":[{"gross_charge":142.11,"discounted_cash":142.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TECHNETIUM TC 99M MEDRONATE IV KIT [98466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"65174-660-30","type":"NDC"}],"standard_charges":[{"gross_charge":99.51,"discounted_cash":99.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":99.51,"discounted_cash":99.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M MERTIATIDE [4089916]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"69945-096-20","type":"NDC"}],"standard_charges":[{"gross_charge":1461.39,"discounted_cash":1461.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TENECTEPLASE 50 MG IV KIT [28530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242-120-47","type":"NDC"}],"standard_charges":[{"gross_charge":17186.09,"discounted_cash":17186.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":20050.43,"discounted_cash":20050.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":22914.78,"discounted_cash":22914.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":25779.13,"discounted_cash":25779.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":28643.47,"discounted_cash":28643.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TENECTEPLASE 50 MG IV KIT [28530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242-037-06","type":"NDC"}],"standard_charges":[{"gross_charge":17186.09,"discounted_cash":17186.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":20050.43,"discounted_cash":20050.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":22914.78,"discounted_cash":22914.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":25779.13,"discounted_cash":25779.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":28643.47,"discounted_cash":28643.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TEMSIROLIMUS 25 MG/ML IV SOLN [82228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9330","type":"HCPCS"},{"code":"16729-223-61","type":"NDC"}],"standard_charges":[{"gross_charge":4808.99,"discounted_cash":4808.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"TEMAZEPAM 7.5 MG PO CAPS [11500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6436-04","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS [132885]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61958-2301-1","type":"NDC"}],"standard_charges":[{"gross_charge":316.91,"discounted_cash":316.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"TEMAZEPAM 15 MG PO CAPS [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-146-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS [31684]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-714-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TERAZOSIN HCL 1 MG PO CAPS [14550]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-383-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TERBINAFINE HCL 250 MG PO TABS [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-526-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"TERBINAFINE HCL 250 MG PO TABS [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-795-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"TERBINAFINE HCL 1 % EX CREA [27023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-2080-2","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"TERBINAFINE HCL 1 % EX CREA [27023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-2080-1","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TERBINAFINE HCL 1 % EX CREA [27023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24385-524-05","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"TERBINAFINE HCL 1 % EX CREA [27023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24385-524-03","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"TERBINAFINE HCL 1 % EX CREA [27023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0067-8100-30","type":"NDC"}],"standard_charges":[{"gross_charge":7.38,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"TERAZOSIN HCL 5 MG PO CAPS [14553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-385-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TEMAZEPAM 15 MG PO CAPS [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-779-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TELMISARTAN 40 MG PO TABS [24335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13668-157-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TECHNETIUM TC 99M TILMANOCEPT IJ KIT [150475]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"65857-450-05","type":"NDC"}],"standard_charges":[{"gross_charge":4473.27,"discounted_cash":4473.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M TETROFOSMIN IV KIT [4089902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999100210","type":"NDC"}],"standard_charges":[{"gross_charge":291.02,"discounted_cash":291.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M SULFUR COLLOID [4089907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999100710","type":"NDC"}],"standard_charges":[{"gross_charge":3835.98,"discounted_cash":3835.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":767.2,"discounted_cash":767.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MILLICURIE"},{"gross_charge":3068.79,"discounted_cash":3068.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M SESTAMIBI [4089903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"69945-092-40","type":"NDC"}],"standard_charges":[{"gross_charge":213.98,"discounted_cash":213.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M PYROPHOS IV KIT [132017]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"45567-0060-1","type":"NDC"}],"standard_charges":[{"gross_charge":444.94,"discounted_cash":444.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M PERTECHNETATE [4089923]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"A9512","type":"HCPCS"},{"code":"99999102310","type":"NDC"}],"standard_charges":[{"gross_charge":141.36,"discounted_cash":141.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M PENTETATE IV KIT EMERGENCY KIT [40819905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"9999-2200-10","type":"NDC"}],"standard_charges":[{"gross_charge":2689.35,"discounted_cash":2689.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TECHNETIUM TC 99M PENTETATE IV KIT [109481]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"65174-288-30","type":"NDC"}],"standard_charges":[{"gross_charge":950.87,"discounted_cash":950.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"TELMISARTAN 80 MG PO TABS [24336]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62332-089-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TEMAZEPAM 15 MG PO CAPS [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-779-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TEMAZEPAM 15 MG PO CAPS [7753]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2076-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TELMISARTAN 80 MG PO TABS [24336]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68462-201-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TELMISARTAN 80 MG PO TABS [24336]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382-473-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"TERBINAFINE HCL 250 MG PO TABS [12724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-079-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"TACROLIMUS 0.5 MG/ML PO SUSP [40840050]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-0153-99","type":"NDC"}],"standard_charges":[{"gross_charge":40.26,"discounted_cash":40.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"0409-6629-02","type":"NDC"}],"standard_charges":[{"gross_charge":132.16,"discounted_cash":132.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCCIMER 100 MG PO CAPS [11438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55292-201-11","type":"NDC"}],"standard_charges":[{"gross_charge":77.19,"discounted_cash":77.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"SUBCUTANEOUS IMMUNOTHERAPY IJ [133220]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-9999-46","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DOSE"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DOSE"},{"gross_charge":126.0,"discounted_cash":126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 DOSE"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7973-08","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"0409-6629-12","type":"NDC"}],"standard_charges":[{"gross_charge":126.63,"discounted_cash":126.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7973-05","type":"NDC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":70.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0004-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0004-03","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0004-02","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-7386-60","type":"NDC"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":136.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3000 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-2101-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-2101-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"STERILE WATER FOR IRRIGATION IR SOLN [7485]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-7139-09","type":"NDC"}],"standard_charges":[{"gross_charge":368.05,"discounted_cash":368.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"43598-666-11","type":"NDC"}],"standard_charges":[{"gross_charge":56.46,"discounted_cash":56.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"43598-666-25","type":"NDC"}],"standard_charges":[{"gross_charge":56.14,"discounted_cash":56.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918-700-02","type":"NDC"}],"standard_charges":[{"gross_charge":1338.09,"discounted_cash":1338.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0974-40","type":"NDC"}],"standard_charges":[{"gross_charge":31.08,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":62.16,"discounted_cash":62.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0974-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.45,"discounted_cash":33.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":66.9,"discounted_cash":66.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69762-401-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62135-436-90","type":"NDC"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":47.31,"discounted_cash":47.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0401-5","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0401-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCRALFATE 1 G PO TABS [11442]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58914-171-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918-700-26","type":"NDC"}],"standard_charges":[{"gross_charge":55.6,"discounted_cash":55.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN [7536]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918-700-03","type":"NDC"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"STERILE WATER FOR INJECTION IV SOLN [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0990-7118-07","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":82.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"STERILE WATER FOR INJECTION IV SOLN [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0013-06","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 ML"}]},{"description":"STERILE WATER FOR INJECTION IV SOLN [28400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0013-04","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"STAVUDINE 20 MG PO CAPS [13309]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-516-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6927-61","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 100 MG PO TABS [11425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-487-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 100 MG PO TABS [11425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-515-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SOTALOL HCL 80 MG PO TABS [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-114-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SOTALOL HCL 80 MG PO TABS [11421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0080-0","type":"NDC"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-103-20","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-465-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SPIRONOLACTONE 25 MG PO TABS [7437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-143-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7269-66","type":"NDC"}],"standard_charges":[{"gross_charge":30.66,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":61.32,"discounted_cash":61.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP [11441]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-148-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.1,"discounted_cash":38.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":76.2,"discounted_cash":76.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUVOREXANT 10 MG PO TABS [127197]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0006-0033-10","type":"NDC"}],"standard_charges":[{"gross_charge":88.08,"discounted_cash":88.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":132.12,"discounted_cash":132.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":176.16,"discounted_cash":176.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":44.04,"discounted_cash":44.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"SUNITINIB MALATE 25 MG PO CAPS [70425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0069-0770-38","type":"NDC"}],"standard_charges":[{"gross_charge":1037.0,"discounted_cash":1037.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":1037.0,"discounted_cash":1037.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":2073.99,"discounted_cash":2073.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"},{"gross_charge":2073.99,"discounted_cash":2073.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"64679-728-08","type":"NDC"}],"standard_charges":[{"gross_charge":54.99,"discounted_cash":54.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"64679-728-01","type":"NDC"}],"standard_charges":[{"gross_charge":122.18,"discounted_cash":122.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-273-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.57,"discounted_cash":60.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.45,"discounted_cash":45.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3174-14","type":"NDC"}],"standard_charges":[{"gross_charge":432.24,"discounted_cash":432.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN [97343]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9638-01","type":"NDC"}],"standard_charges":[{"gross_charge":256.12,"discounted_cash":256.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"SUMATRIPTAN SUCCINATE 25 MG PO TABS [15327]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-291-36","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"SULINDAC 200 MG PO TABS [7579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"SULFUR HEXAFLUORIDE MICROSPH 60.7-25 MG IJ SUSR [148387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0270-7099-16","type":"NDC"}],"standard_charges":[{"gross_charge":294.05,"discounted_cash":294.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"},{"gross_charge":490.08,"discounted_cash":490.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 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Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 0.5 MG PO CAPS [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68462-685-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 0.5 MG PO CAPS [24914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"16729-041-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"TACROLIMUS 0.1 % EX OINT [29443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68462-534-35","type":"NDC"}],"standard_charges":[{"gross_charge":106.02,"discounted_cash":106.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"TACROLIMUS 0.1 % EX OINT [29443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-700-00","type":"NDC"}],"standard_charges":[{"gross_charge":109.8,"discounted_cash":109.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"TACROLIMUS 0.1 % EX OINT [29443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0168-0416-30","type":"NDC"}],"standard_charges":[{"gross_charge":704.16,"discounted_cash":704.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"SWEET OIL N/A OIL [7651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0395-2063-11","type":"NDC"}],"standard_charges":[{"gross_charge":27.36,"discounted_cash":27.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SULFASALAZINE 500 MG PO TABS [7562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5000-5","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFADIAZINE 500 MG PO TABS [7554]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0757-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.29,"discounted_cash":48.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":24.15,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFACETAMIDE-PREDNISOLONE 10-0.2 % OP OINT [11448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-0313-04","type":"NDC"}],"standard_charges":[{"gross_charge":735.51,"discounted_cash":735.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"SULFACETAMIDE SODIUM 10 % OP SOLN [7359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24208-670-04","type":"NDC"}],"standard_charges":[{"gross_charge":220.41,"discounted_cash":220.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"SULBACTAM SODIUM 1 G IV SOLR [408152177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68547-211-20","type":"NDC"}],"standard_charges":[{"gross_charge":1087.53,"discounted_cash":1087.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"SULBACTAM SOD-DURLOBACTAM SOD 1-1 G IV SOLR [152176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68547-111-10","type":"NDC"}],"standard_charges":[{"gross_charge":2150.06,"discounted_cash":2150.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"SUGAMMADEX SODIUM 500 MG/5ML IV SOLN [130106]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-5425-15","type":"NDC"}],"standard_charges":[{"gross_charge":1499.32,"discounted_cash":1499.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SUGAMMADEX SODIUM 200 MG/2ML IV SOLN [130104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-5423-12","type":"NDC"}],"standard_charges":[{"gross_charge":829.95,"discounted_cash":829.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUGAMMADEX SODIUM 200 MG/2ML IV SOLN [130104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0006-5423-02","type":"NDC"}],"standard_charges":[{"gross_charge":678.79,"discounted_cash":678.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUFENTANIL CITRATE 50 MCG/ML IV SOLN [11443]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SUFENTANIL CITRATE 100 MCG/2ML IV SOLN [98287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-050-02","type":"NDC"}],"standard_charges":[{"gross_charge":69.38,"discounted_cash":69.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUFENTANIL CITRATE 100 MCG/2ML IV SOLN [98287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3382-22","type":"NDC"}],"standard_charges":[{"gross_charge":47.71,"discounted_cash":47.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUCROFERRIC OXYHYDROXIDE 500 MG PO CHEW [124858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49230-645-51","type":"NDC"}],"standard_charges":[{"gross_charge":275.27,"discounted_cash":275.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":137.64,"discounted_cash":137.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.0001-0.0005 MG/ML IV SOLN (STOCK C) [40890049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999600325","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.01-0.05 MG/ML IV SOLN (STOCK B) 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[7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-362-10","type":"NDC"}],"standard_charges":[{"gross_charge":67.12,"discounted_cash":67.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-362-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.12,"discounted_cash":67.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN [7556]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-9514-03","type":"NDC"}],"standard_charges":[{"gross_charge":59.26,"discounted_cash":59.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS [7557]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP [22560]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-496-03","type":"NDC"}],"standard_charges":[{"gross_charge":38.52,"discounted_cash":38.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 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TRIMETHOPRIM"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.4-2 MG/ML PO SUSP (STOCK A) [40890069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-6003-30","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 0.004-0.02 MG/ML PO SUSP (STOCK B) [40890070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-6003-33","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN 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[11562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-801-05","type":"NDC"}],"standard_charges":[{"gross_charge":32.37,"discounted_cash":32.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN [11562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-288-12","type":"NDC"}],"standard_charges":[{"gross_charge":76.41,"discounted_cash":76.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN [11562]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-288-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.12,"discounted_cash":42.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLG [24576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-819-05","type":"NDC"}],"standard_charges":[{"gross_charge":129.12,"discounted_cash":129.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN [11561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-513-01","type":"NDC"}],"standard_charges":[{"gross_charge":57.66,"discounted_cash":57.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TINIDAZOLE 500 MG PO TABS [38907]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42799-208-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"TIZANIDINE HCL 4 MG PO TABS 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[39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3578-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN [97790]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457-428-30","type":"NDC"}],"standard_charges":[{"gross_charge":90.87,"discounted_cash":90.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN [97790]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457-428-00","type":"NDC"}],"standard_charges":[{"gross_charge":90.87,"discounted_cash":90.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G IJ SOLR [11565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"39822-0412-6","type":"NDC"}],"standard_charges":[{"gross_charge":247.6,"discounted_cash":247.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G IJ SOLR [11565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"39822-0412-1","type":"NDC"}],"standard_charges":[{"gross_charge":353.77,"discounted_cash":353.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"}]},{"description":"TOBRAMYCIN FORTIFIED OPHTHALMIC DROPS CMPD 15 MG/ML [4081167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-6003-63","type":"NDC"}],"standard_charges":[{"gross_charge":57.62,"discounted_cash":57.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TOBRAMYCIN 300 MG/5ML IN NEBU [22240]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"47335-171-49","type":"NDC"}],"standard_charges":[{"gross_charge":52.46,"discounted_cash":52.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"TOBRAMYCIN 0.3 % OP SOLN [7995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-518-05","type":"NDC"}],"standard_charges":[{"gross_charge":92.58,"discounted_cash":92.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN 0.3 % OP SOLN [7995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-643-05","type":"NDC"}],"standard_charges":[{"gross_charge":62.52,"discounted_cash":62.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN 0.3 % OP OINT [19769]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0813-01","type":"NDC"}],"standard_charges":[{"gross_charge":1448.65,"discounted_cash":1448.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"TOBRAMYCIN 0.3 % OP OINT [19769]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0644-35","type":"NDC"}],"standard_charges":[{"gross_charge":1121.11,"discounted_cash":1121.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN [11561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-226-10","type":"NDC"}],"standard_charges":[{"gross_charge":66.18,"discounted_cash":66.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN [11561]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60758-802-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLG [24575]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-818-25","type":"NDC"}],"standard_charges":[{"gross_charge":998.12,"discounted_cash":998.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE (ONCE-DAILY) 0.5 % OP SOLN [70283]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-045-50","type":"NDC"}],"standard_charges":[{"gross_charge":580.23,"discounted_cash":580.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIAGABINE HCL 4 MG PO TABS [21827]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62756-224-83","type":"NDC"}],"standard_charges":[{"gross_charge":59.26,"discounted_cash":59.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":79.01,"discounted_cash":79.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":19.76,"discounted_cash":19.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TIAGABINE HCL 2 MG PO TABS [27178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"62756-200-83","type":"NDC"}],"standard_charges":[{"gross_charge":144.87,"discounted_cash":144.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":193.16,"discounted_cash":193.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":24.15,"discounted_cash":24.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":48.29,"discounted_cash":48.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TIAGABINE HCL 2 MG PO TABS [27178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0093-5030-56","type":"NDC"}],"standard_charges":[{"gross_charge":205.49,"discounted_cash":205.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":273.99,"discounted_cash":273.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":34.25,"discounted_cash":34.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":68.5,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"THYROTROPIN ALFA 0.9 MG IM SOLR [146554]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58468-0030-2","type":"NDC"}],"standard_charges":[{"gross_charge":7976.5,"discounted_cash":7976.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"}]},{"description":"THYROTROPIN ALFA 0.9 MG IM SOLR [146554]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58468-0030-1","type":"NDC"}],"standard_charges":[{"gross_charge":7004.86,"discounted_cash":7004.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"}]},{"description":"THYROID 300 MG PO TABS [7945]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-0464-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-473-00","type":"NDC"}],"standard_charges":[{"gross_charge":48.92,"discounted_cash":48.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TICAGRELOR 60 MG PO TABS [129269]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0776-60","type":"NDC"}],"standard_charges":[{"gross_charge":136.71,"discounted_cash":136.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":45.57,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":68.36,"discounted_cash":68.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TIGECYCLINE 50 MG/5ML IV (WET SOLR VIAL) [150462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"0008-4994-20","type":"NDC"}],"standard_charges":[{"gross_charge":134.98,"discounted_cash":134.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TIGECYCLINE 50 MG IV SOLR [41652]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3243","type":"HCPCS"},{"code":"71288-019-10","type":"NDC"}],"standard_charges":[{"gross_charge":294.03,"discounted_cash":294.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TICAGRELOR 90 MG PO TABS [110427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-491-60","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TICAGRELOR 90 MG PO TABS [110427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42658-115-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TICAGRELOR 90 MG PO TABS [110427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0777-60","type":"NDC"}],"standard_charges":[{"gross_charge":82.88,"discounted_cash":82.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":27.63,"discounted_cash":27.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":41.44,"discounted_cash":41.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TICAGRELOR 90 MG PO TABS [110427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0777-39","type":"NDC"}],"standard_charges":[{"gross_charge":91.14,"discounted_cash":91.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":45.57,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":45.57,"discounted_cash":45.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN [39918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-473-22","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TOBRAMYCIN SULFATE INHALATION SOLUTION [40839918]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-306-02","type":"NDC"}],"standard_charges":[{"gross_charge":45.2,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"TORSEMIDE 20 MG PO TABS [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-917-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 20 MG PO TABS [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0077-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 100 MG PO TABS [18294]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-128-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TORSEMIDE 10 MG PO TABS [18292]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-126-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TOPOTECAN HCL 4 MG/4ML IV SOLN [108590]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"0409-0302-01","type":"NDC"}],"standard_charges":[{"gross_charge":190.45,"discounted_cash":190.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TOPIRAMATE ER 50 MG PO CS24 [125889]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1040-3","type":"NDC"}],"standard_charges":[{"gross_charge":54.86,"discounted_cash":54.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":109.71,"discounted_cash":109.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":27.43,"discounted_cash":27.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TOPIRAMATE ER 50 MG PO CS24 [125889]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-373-30","type":"NDC"}],"standard_charges":[{"gross_charge":58.01,"discounted_cash":58.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":116.02,"discounted_cash":116.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":29.01,"discounted_cash":29.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TORSEMIDE 20 MG PO TABS [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-140-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7179-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRAMADOL HCL 50 MG PO TABS [14632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0058-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN [146460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9302-25","type":"NDC"}],"standard_charges":[{"gross_charge":144.63,"discounted_cash":144.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN [146460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9302-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.47,"discounted_cash":117.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRACE MINERALS CR-CU-MN-ZN 1-100-30-500 MCG/ML IV SOLN [18265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9310-25","type":"NDC"}],"standard_charges":[{"gross_charge":46.53,"discounted_cash":46.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN [18266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9203-25","type":"NDC"}],"standard_charges":[{"gross_charge":92.86,"discounted_cash":92.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"TRABECTEDIN 1 MG IV SOLR [129494]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9352","type":"HCPCS"},{"code":"59676-610-01","type":"NDC"}],"standard_charges":[{"gross_charge":13791.53,"discounted_cash":13791.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TORSEMIDE 20 MG PO TABS [18293]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-127-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"TOPIRAMATE 25 MG PO TABS [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-342-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOLTERODINE TARTRATE ER 2 MG PO CP24 [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-189-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOLTERODINE TARTRATE 1 MG PO TABS [22782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0170-6","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLTERODINE TARTRATE 1 MG PO TABS [22782]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-239-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TOLNAFTATE 1 % EX POWD [8021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0726-45","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"TOLNAFTATE 1 % EX CREA [8020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2020-2","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"TOLNAFTATE 1 % EX CREA [8020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0722-36","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.18 G"}]},{"description":"TOLNAFTATE 1 % EX CREA [8020]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1315-43","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.18 G"}]},{"description":"TOCILIZUMAB 200 MG/10ML IV SOLN [108062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0249","type":"HCPCS"},{"code":"50242-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":4848.88,"discounted_cash":4848.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TOCILIZUMAB 162 MG/0.9ML SC SOSY [124122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0249","type":"HCPCS"},{"code":"50242-138-01","type":"NDC"}],"standard_charges":[{"gross_charge":3712.8,"discounted_cash":3712.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP [11567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-647-25","type":"NDC"}],"standard_charges":[{"gross_charge":211.8,"discounted_cash":211.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP [11567]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0647-25","type":"NDC"}],"standard_charges":[{"gross_charge":406.2,"discounted_cash":406.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT [11566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0876-01","type":"NDC"}],"standard_charges":[{"gross_charge":1542.31,"discounted_cash":1542.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"TOLTERODINE TARTRATE ER 2 MG PO CP24 [29434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-160-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOPIRAMATE 25 MG PO TABS [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-108-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOLTERODINE TARTRATE ER 4 MG PO CP24 [29435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-192-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"TOPIRAMATE 25 MG PO TABS [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-707-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 25 MG PO TABS [18920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6928-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 100 MG PO TABS [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-109-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 100 MG PO TABS [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-344-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 100 MG PO TABS [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-173-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOPIRAMATE 100 MG PO TABS [18922]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6929-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TOLVAPTAN 30 MG PO TABS [97894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-636-33","type":"NDC"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":153.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":306.99,"discounted_cash":306.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":613.97,"discounted_cash":613.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"TOLVAPTAN 30 MG PO TABS [97894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-636-02","type":"NDC"}],"standard_charges":[{"gross_charge":334.75,"discounted_cash":334.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":669.5,"discounted_cash":669.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":1339.0,"discounted_cash":1339.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"TOLVAPTAN 15 MG PO TABS [97893]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-768-54","type":"NDC"}],"standard_charges":[{"gross_charge":283.82,"discounted_cash":283.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":567.64,"discounted_cash":567.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 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[125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"52536-625-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.93,"discounted_cash":132.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY [146541]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58160-842-43","type":"NDC"}],"standard_charges":[{"gross_charge":224.13,"discounted_cash":224.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN [7795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58768-787-12","type":"NDC"}],"standard_charges":[{"gross_charge":19.65,"discounted_cash":19.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN [7795]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68682-920-64","type":"NDC"}],"standard_charges":[{"gross_charge":502.65,"discounted_cash":502.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TETRACAINE HCL 1 % IJ SOLN [11517]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-045-32","type":"NDC"}],"standard_charges":[{"gross_charge":478.92,"discounted_cash":478.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"THEOPHYLLINE ER 200 MG PO CP24 [27419]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52244-200-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.01,"discounted_cash":34.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":68.01,"discounted_cash":68.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":102.01,"discounted_cash":102.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"THEOPHYLLINE 80 MG/15ML PO SOLN [7821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-258-71","type":"NDC"}],"standard_charges":[{"gross_charge":47.52,"discounted_cash":47.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"THEOPHYLLINE 80 MG/15ML PO SOLN [7821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-258-44","type":"NDC"}],"standard_charges":[{"gross_charge":56.61,"discounted_cash":56.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"THEOPHYLLINE 80 MG/15ML PO SOLN [7821]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-0038-1","type":"NDC"}],"standard_charges":[{"gross_charge":45.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"THEOPHYLLINE 80 MG/15ML PO ELIX [7820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4820-40","type":"NDC"}],"standard_charges":[{"gross_charge":50.04,"discounted_cash":50.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"THEOPHYLLINE 80 MG/15ML PO ELIX [7820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4820-15","type":"NDC"}],"standard_charges":[{"gross_charge":52.29,"discounted_cash":52.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"THALLIUM TI 201 [4089920]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999102010","type":"NDC"}],"standard_charges":[{"gross_charge":539.28,"discounted_cash":539.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"},{"gross_charge":539.28,"discounted_cash":539.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 MILLICURIE"}]},{"description":"TETRAHYDROZOLINE HCL 0.05 % OP SOLN 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[7800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12547-49380","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TETRACYCLINE HCL 250 MG PO CAPS [7796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-766-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"47781-911-93","type":"NDC"}],"standard_charges":[{"gross_charge":138.57,"discounted_cash":138.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"0574-0827-10","type":"NDC"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"0574-0827-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.5,"discounted_cash":107.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"0409-6562-22","type":"NDC"}],"standard_charges":[{"gross_charge":580.96,"discounted_cash":580.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TERBUTALINE SULFATE 2.5 MG PO TABS [11508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1318-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TERBUTALINE SULFATE 2.5 MG PO TABS [11508]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-2611-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML INH SOLN [40811507]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-665-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML INH SOLN [40811507]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-665-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"THEOPHYLLINE ER 300 MG PO CP24 [27421]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52244-300-10","type":"NDC"}],"standard_charges":[{"gross_charge":38.45,"discounted_cash":38.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":51.27,"discounted_cash":51.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":76.9,"discounted_cash":76.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"TERIPARATIDE 560 MCG/2.24ML SC SOPN [156496]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J3110","type":"HCPCS"},{"code":"0093-1106-16","type":"NDC"}],"standard_charges":[{"gross_charge":3806.36,"discounted_cash":3806.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.24 ML"}]},{"description":"TESTOSTERONE 25 MG/2.5GM (1%) TD GEL [108038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3216-17","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG OF TESTOSTERONE"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG OF TESTOSTERONE"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"0409-6562-02","type":"NDC"}],"standard_charges":[{"gross_charge":141.08,"discounted_cash":141.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"0409-6562-01","type":"NDC"}],"standard_charges":[{"gross_charge":86.25,"discounted_cash":86.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"0143-9726-01","type":"NDC"}],"standard_charges":[{"gross_charge":162.94,"discounted_cash":162.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN [125831]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"0009-0417-02","type":"NDC"}],"standard_charges":[{"gross_charge":261.4,"discounted_cash":261.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TESTOSTERONE 75 MG IL PLLT [27456]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66887-004-10","type":"NDC"}],"standard_charges":[{"gross_charge":968.0,"discounted_cash":968.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1452.0,"discounted_cash":1452.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 MG"},{"gross_charge":1936.0,"discounted_cash":1936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":2420.0,"discounted_cash":2420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":2904.0,"discounted_cash":2904.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"}]},{"description":"TESTOSTERONE 25 MG/2.5GM (1%) TD GEL [108038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-151-02","type":"NDC"}],"standard_charges":[{"gross_charge":18.17,"discounted_cash":18.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG OF TESTOSTERONE"},{"gross_charge":36.33,"discounted_cash":36.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG OF TESTOSTERONE"}]},{"description":"TESTOSTERONE 25 MG/2.5GM (1%) TD GEL [108038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-151-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.51,"discounted_cash":33.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG OF TESTOSTERONE"},{"gross_charge":67.02,"discounted_cash":67.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG OF TESTOSTERONE"}]},{"description":"TESTOSTERONE 25 MG/2.5GM (1%) TD GEL [108038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3216-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG OF TESTOSTERONE"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG OF TESTOSTERONE"}]},{"description":"THEOPHYLLINE ER 300 MG PO TB12 [12098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-025-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 450 MG"}]},{"description":"THIOTHIXENE 5 MG PO CAPS [7906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-016-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIOTHIXENE 5 MG PO CAPS [7906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-588-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIOTHIXENE 5 MG PO CAPS [7906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3005-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"THIORIDAZINE HCL 25 MG PO TABS [7899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-566-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72485-507-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":140.02,"discounted_cash":140.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-196-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":108.39,"discounted_cash":108.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THROMBIN (RECOMBINANT) 20000 UNITS EX SOLR [91965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0326-01","type":"NDC"}],"standard_charges":[{"gross_charge":1666.96,"discounted_cash":1666.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR [89570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0324-01","type":"NDC"}],"standard_charges":[{"gross_charge":308.42,"discounted_cash":308.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"}]},{"description":"THYROID 30 MG PO TABS [7944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-0458-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"THYMOL IODIDE N/A POWD [7936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-7005-10","type":"NDC"}],"standard_charges":[{"gross_charge":253.41,"discounted_cash":253.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"THROMBIN 5000 UNITS FLOWABLE HEMOSTAT [4080073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-1076-10","type":"NDC"}],"standard_charges":[{"gross_charge":291.28,"discounted_cash":291.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"}]},{"description":"THROMBIN 5000 UNITS EX SOLR [11548]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-215-05","type":"NDC"}],"standard_charges":[{"gross_charge":291.28,"discounted_cash":291.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"}]},{"description":"THROMBIN 5000 UNITS EX KIT [87798]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-705-05","type":"NDC"}],"standard_charges":[{"gross_charge":323.96,"discounted_cash":323.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"}]},{"description":"THROMBIN 20000 UNITS EX SOLR [11547]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-217-20","type":"NDC"}],"standard_charges":[{"gross_charge":1148.67,"discounted_cash":1148.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"THROMBIN 20000 UNITS EX KIT [11544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-217-22","type":"NDC"}],"standard_charges":[{"gross_charge":1314.63,"discounted_cash":1314.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20000 UNITS"}]},{"description":"THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR [89570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-0322-01","type":"NDC"}],"standard_charges":[{"gross_charge":416.79,"discounted_cash":416.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5000 UNITS"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-013-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":146.95,"discounted_cash":146.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6228-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":201.43,"discounted_cash":201.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL 100 MG PO TABS [7877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11845-05651","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THERA-GESIC 1-15 % EX CREA [108440]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-116-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"THERA-GESIC 1-15 % EX CREA [108440]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41167-600-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"THERA PO TABS [7825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681-00300","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"THEOPHYLLINE ER 400 MG PO TB24 [36973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-701-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"THEOPHYLLINE ER 400 MG PO TB24 [36973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29033-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-500-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":120.73,"discounted_cash":120.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-013-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":146.95,"discounted_cash":146.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-273-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":113.38,"discounted_cash":113.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-050-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":115.72,"discounted_cash":115.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN [7876]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-050-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":116.28,"discounted_cash":116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PRAZOSIN HCL 5 MG PO CAPS [6470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-572-33","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG PO TBEC [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68084-907-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.14,"discounted_cash":19.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 180 MG"},{"gross_charge":38.27,"discounted_cash":38.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":76.54,"discounted_cash":76.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG PO TBEC [38062]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67877-426-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge 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[24932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0024-2794-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.79,"discounted_cash":78.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.5 MG"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN [24932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"0024-2792-01","type":"NDC"}],"standard_charges":[{"gross_charge":157.94,"discounted_cash":157.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN [24932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0024-2792-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.97,"discounted_cash":78.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.5 MG"}]},{"description":"NA CHONDROIT SULF-NA HYALURON 20-15 MG/0.5ML IO SOSY [146563]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"8065-183905","type":"NDC"}],"standard_charges":[{"gross_charge":500.73,"discounted_cash":500.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG PO TBEC [38063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70748-218-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG PO TBEC [38063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68084-918-95","type":"NDC"}],"standard_charges":[{"gross_charge":39.07,"discounted_cash":39.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":78.14,"discounted_cash":78.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG PO TBEC [38063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0904-6786-04","type":"NDC"}],"standard_charges":[{"gross_charge":41.8,"discounted_cash":41.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 MG"},{"gross_charge":83.6,"discounted_cash":83.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 720 MG"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG PO TBEC [38063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0078-0386-66","type":"NDC"}],"standard_charges":[{"gross_charge":54.7,"discounted_cash":54.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 360 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[40831906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-323-25","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MOXIFLOXACIN HCL 400 MG/250ML IV SOLN WR [40831906]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-850-74","type":"NDC"}],"standard_charges":[{"gross_charge":218.5,"discounted_cash":218.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MOXIFLOXACIN HCL 400 MG PO TABS [26854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"72205-001-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MOXIFLOXACIN HCL 400 MG PO TABS [26854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65862-603-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MOXIFLOXACIN HCL 400 MG PO TABS [26854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51991-943-33","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MOXIFLOXACIN HCL 400 MG PO TABS [26854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"13668-201-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN [35699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68180-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":52.64,"discounted_cash":52.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN [35699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-0582-4","type":"NDC"}],"standard_charges":[{"gross_charge":400.04,"discounted_cash":400.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN [35699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-7135-93","type":"NDC"}],"standard_charges":[{"gross_charge":35.97,"discounted_cash":35.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOUTH KOTE MT SOLN [92764]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50930-09808","type":"NDC"}],"standard_charges":[{"gross_charge":73.44,"discounted_cash":73.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 236 ML"}]},{"description":"MOUTH KOTE MT SOLN [92764]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50930-09802","type":"NDC"}],"standard_charges":[{"gross_charge":36.47,"discounted_cash":36.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 59 ML"}]},{"description":"MORPHINE SULFATE-NACL 100-0.9 MG/100ML-% IV SOLN [134970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"99999-179-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MORPHINE SULFATE-NACL 100-0.9 MG/100ML-% IV SOLN [134970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092-1380-36","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MORPHINE SULFATE ER BEADS 30 MG PO CP24 [32709]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-3090-11","type":"NDC"}],"standard_charges":[{"gross_charge":149.21,"discounted_cash":149.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":37.31,"discounted_cash":37.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":74.61,"discounted_cash":74.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":111.91,"discounted_cash":111.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN [24932]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"0143-9570-01","type":"NDC"}],"standard_charges":[{"gross_charge":394.82,"discounted_cash":394.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"}]},{"description":"MULTIGEN 70 MG PO TABS [93008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-543-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"MULTIVITAMIN/ZINC STRESS PO TABS 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Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR [25005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"66689-307-08","type":"NDC"}],"standard_charges":[{"gross_charge":70.26,"discounted_cash":70.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":17.57,"discounted_cash":17.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":35.13,"discounted_cash":35.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-020-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-020-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-020-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1312-0","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 G"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-568-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-568-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"MUPIROCIN 2 % EX OINT [10674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1010-42","type":"NDC"}],"standard_charges":[{"gross_charge":191.64,"discounted_cash":191.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 G"}]},{"description":"MULTI-VITE PO LIQD [139650]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-0010-2","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MULTIVITAMIN/ZINC STRESS PO TABS [142697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"80681-11200","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"MULTIVITAMIN DROPS/IRON 11 MG/ML PO SOLN [137136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0087-0405-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.4,"discounted_cash":59.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"NA HYALUR & NA CHOND-NA HYALUR 0.55-0.5 ML IO KIT [28917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"8065-183150","type":"NDC"}],"standard_charges":[{"gross_charge":713.94,"discounted_cash":713.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.05 ML"}]},{"description":"NA SULFATE-K SULFATE-MG SULF 17.5-3.13-1.6 GM/177ML PO SOLN [106061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52268-011-01","type":"NDC"}],"standard_charges":[{"gross_charge":423.15,"discounted_cash":423.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"NA SULFATE-K SULFATE-MG SULF 17.5-3.13-1.6 GM/177ML PO SOLN [106061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52268-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":150.81,"discounted_cash":150.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"NALOXEGOL OXALATE 25 MG PO TABS [127585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"57841-1301-3","type":"NDC"}],"standard_charges":[{"gross_charge":39.45,"discounted_cash":39.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":78.89,"discounted_cash":78.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"NALMEFENE HCL 1 MG/ML IJ SOLN [15099]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59011-960-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":50.6,"discounted_cash":50.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":101.2,"discounted_cash":101.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"NALBUPHINE HCL 10 MG/ML IJ SOLN [5339]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1463-71","type":"NDC"}],"standard_charges":[{"gross_charge":45.24,"discounted_cash":45.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":90.47,"discounted_cash":90.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NALBUPHINE HCL 10 MG/ML IJ SOLN [5339]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1463-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.47,"discounted_cash":47.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":94.94,"discounted_cash":94.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NAFCILLIN SODIUM 2 G/8ML IJ (WET SOLR VIAL) [150459]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-328-22","type":"NDC"}],"standard_charges":[{"gross_charge":60.81,"discounted_cash":60.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NAFCILLIN SODIUM 1 G/4ML IJ (WET SOLR VIAL) [150456]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-122-15","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":55.75,"discounted_cash":55.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"NALOXEGOL OXALATE 25 MG PO TABS [127585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"82625-8802-1","type":"NDC"}],"standard_charges":[{"gross_charge":43.01,"discounted_cash":43.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":86.01,"discounted_cash":86.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"NADOLOL 40 MG PO TABS [5331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1124-9","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN [5373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"36000-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":49.32,"discounted_cash":49.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":123.28,"discounted_cash":123.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"NALOXONE HCL 4 MG/10ML IJ SOLN [132114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-072-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":55.35,"discounted_cash":55.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":138.36,"discounted_cash":138.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"NALOXONE HCL 4 MG/10ML IJ SOLN [132114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-328-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":60.54,"discounted_cash":60.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"NALOXONE HCL 4 MG/10ML IJ SOLN [132114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1219-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY [132115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-992-02","type":"NDC"}],"standard_charges":[{"gross_charge":210.42,"discounted_cash":210.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"NADOLOL 20 MG PO TABS [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-812-20","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 20 MG PO TABS [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-812-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 20 MG PO TABS [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7070-07","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NABUMETONE 500 MG PO TABS [10676]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NADOLOL 20 MG PO TABS [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-302-25","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 40 MG PO TABS [5331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-868-07","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NADOLOL 20 MG PO TABS [5330]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-302-95","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"NALTREXONE 380 MG IM SUSR [76527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2315","type":"HCPCS"},{"code":"65757-300-01","type":"NDC"}],"standard_charges":[{"gross_charge":6165.42,"discounted_cash":6165.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 380 MG"}]},{"description":"MORPHINE SULFATE ER 60 MG PO TBCR [120996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8380-62","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN [15852]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3815-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 20 MG/ML PO SOLN [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1110-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 20 MG/ML PO SOLN [10655]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8003-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN [15852]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3815-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"MONTELUKAST SODIUM 4 MG PO CHEW [27234]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-727-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-875-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-361-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-725-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IV SOLN [117977]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1893-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IV SOLN [117977]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1893-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IJ SOLN WR [4080097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-451-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IJ SOLN WR [4080097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-451-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IJ SOLN WR [4080097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6127-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IJ SOLN WR [4080097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6127-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN WR [40815852]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69374-979-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-575-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-102-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MODAFINIL 100 MG PO TABS [24702]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-621-11","type":"NDC"}],"standard_charges":[{"gross_charge":48.99,"discounted_cash":48.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":97.97,"discounted_cash":97.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MISOPROSTOL 50 MCG PARTIAL TAB [4080066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1030-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"MISOPROSTOL 25 MCG PARTIAL TAB [4080065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1029-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"MISOPROSTOL 200 MCG PO TABS [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5008-2","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG PO TABS [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-5008-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MISOPROSTOL 200 MCG PO TABS [10629]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-161-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IJ SOLN WR [4080099]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1890-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MODAFINIL 100 MG PO TABS [24702]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-621-21","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":54.0,"discounted_cash":54.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MODAFINIL 200 MG PO TABS [24703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6792-04","type":"NDC"}],"standard_charges":[{"gross_charge":22.7,"discounted_cash":22.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":45.39,"discounted_cash":45.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-102-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MONTELUKAST SODIUM 10 MG PO TABS [22509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6808-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MOMETASONE FURO-FORMOTEROL FUM 200-5 MCG/ACT IN AERO [105699]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78206-126-02","type":"NDC"}],"standard_charges":[{"gross_charge":1371.06,"discounted_cash":1371.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 G"}]},{"description":"MOMETASONE FURO-FORMOTEROL FUM 100-5 MCG/ACT IN AERO [105698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78206-127-02","type":"NDC"}],"standard_charges":[{"gross_charge":1371.06,"discounted_cash":1371.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.8 G"}]},{"description":"MOMETASONE FUROATE 220 MCG/ACT IN AEPB [149371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78206-114-03","type":"NDC"}],"standard_charges":[{"gross_charge":229.13,"discounted_cash":229.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MOMETASONE FUROATE 220 MCG/ACT IN AEPB [149371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78206-114-02","type":"NDC"}],"standard_charges":[{"gross_charge":1409.07,"discounted_cash":1409.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA [10646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68462-192-17","type":"NDC"}],"standard_charges":[{"gross_charge":104.58,"discounted_cash":104.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"MOMETASONE FUROATE 0.1 % EX CREA [10646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0713-0634-15","type":"NDC"}],"standard_charges":[{"gross_charge":104.67,"discounted_cash":104.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"MOLASSES [4081138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-0012-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MOEXIPRIL HCL 7.5 MG PO TABS [15025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-209-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MORPHINE SULFATE ER 15 MG PO TBCR [120995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 15 MG PO TBCR [120995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6557-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 15 MG PO TBCR [120995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8315-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 100 MG PO TBCR [120997]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 100 MG PO TBCR [120997]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-804-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TBCR [120973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-158-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.84,"discounted_cash":40.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":81.67,"discounted_cash":81.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 60 MG PO TBCR [120996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8380-23","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 60 MG PO TBCR [120996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8380-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE ER 30 MG PO TBCR [120973]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-158-11","type":"NDC"}],"standard_charges":[{"gross_charge":40.84,"discounted_cash":40.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":81.67,"discounted_cash":81.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN [146537]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6125-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE 30 MG PO TABS [5179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0236-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE 1 MG/ML PCA PREMIX WR [40877005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-1520-49","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE"}]},{"description":"MORPHINE SULFATE 1 MG/ML PCA PREMIX WR [40877005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70092-1125-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SYRINGE"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN [117975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1891-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN [117975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1891-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IJ SOLN WR [4080096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-454-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IJ SOLN WR [4080096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-454-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0237-63","type":"NDC"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0904-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-001-59","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE SULFATE 30 MG PO TABS [5179]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0236-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":14.37,"discounted_cash":14.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE 15 MG PO TABS [5178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-236-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE 15 MG PO TABS [5178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0235-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE 15 MG PO TABS [5178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0235-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":16.13,"discounted_cash":16.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-9999-76","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-001-62","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN [5176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0904-94","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MISOPROSTOL 100 MCG PO TABS [10628]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-160-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"NALTREXONE HCL 50 MG PO TABS [10685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-1170-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NORTRIPTYLINE HCL 10 MG PO CAPS [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0810-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORETHINDRONE-ETH ESTRADIOL 1-35 MG-MCG (21) PO TABS [10742]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-394-29","type":"NDC"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 EACH"}]},{"description":"NORETHINDRONE ACETATE 5 MG PO TABS [10747]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-304-50","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NOREPINEPHRINE-DEXTROSE 4-5 MG/250ML-% IV SOLN [131996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0112-20","type":"NDC"}],"standard_charges":[{"gross_charge":138.4,"discounted_cash":138.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE-DEXTROSE 16-5 MG/250ML-% IV SOLN [134994]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"9999-1038-17","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE-DEXTROSE 16-5 MG/250ML-% IV SOLN [134994]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0116-20","type":"NDC"}],"standard_charges":[{"gross_charge":379.0,"discounted_cash":379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 8 MG IN 5% DEXTROSE 250 ML [4084080080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"9999-1904-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 16 MCG/ML INFUSION IN DEXTROSE 5% [4084080078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"99999-004-10","type":"NDC"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN [127991]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-140-02","type":"NDC"}],"standard_charges":[{"gross_charge":44.08,"discounted_cash":44.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE-DEXTROSE 8-5 MG/250ML-% IV SOLN [131998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0108-20","type":"NDC"}],"standard_charges":[{"gross_charge":185.5,"discounted_cash":185.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"NORTRIPTYLINE HCL 10 MG PO CAPS [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4001-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE HCL 25 MG PO CAPS [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4002-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE HCL 10 MG PO CAPS [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-069-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NORTRIPTYLINE HCL 10 MG PO CAPS [5674]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4001-5","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN [127991]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43066-997-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.87,"discounted_cash":49.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN [127991]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0703-1153-03","type":"NDC"}],"standard_charges":[{"gross_charge":132.72,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NIVOLUMAB 40 MG/4ML IV SOLN [127333]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"0003-3772-11","type":"NDC"}],"standard_charges":[{"gross_charge":4151.3,"discounted_cash":4151.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NIVOLUMAB 240 MG/24ML IV SOLN [134282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"0003-3734-13","type":"NDC"}],"standard_charges":[{"gross_charge":29061.8,"discounted_cash":29061.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 ML"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69339-174-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL [5604]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-639-45","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: 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MG"},{"gross_charge":24884.8,"discounted_cash":24884.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS [10724]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0122-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT [5755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1272-1","type":"NDC"}],"standard_charges":[{"gross_charge":87.84,"discounted_cash":87.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX CREA [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-880-94","type":"NDC"}],"standard_charges":[{"gross_charge":34.74,"discounted_cash":34.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-2008-15","type":"NDC"}],"standard_charges":[{"gross_charge":20.16,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-2008-02","type":"NDC"}],"standard_charges":[{"gross_charge":535.88,"discounted_cash":535.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-048-35","type":"NDC"}],"standard_charges":[{"gross_charge":19.8,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-048-11","type":"NDC"}],"standard_charges":[{"gross_charge":83.91,"discounted_cash":83.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0686-15","type":"NDC"}],"standard_charges":[{"gross_charge":83.7,"discounted_cash":83.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT [5750]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0007-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1289-1","type":"NDC"}],"standard_charges":[{"gross_charge":28.53,"discounted_cash":28.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-059-35","type":"NDC"}],"standard_charges":[{"gross_charge":26.28,"discounted_cash":26.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0713-0678-15","type":"NDC"}],"standard_charges":[{"gross_charge":21.51,"discounted_cash":21.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA [5749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0168-0054-15","type":"NDC"}],"standard_charges":[{"gross_charge":21.69,"discounted_cash":21.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NORTRIPTYLINE HCL 25 MG PO CAPS [5675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75907-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-2008-30","type":"NDC"}],"standard_charges":[{"gross_charge":65.87,"discounted_cash":65.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX CREA [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1263-1","type":"NDC"}],"standard_charges":[{"gross_charge":123.03,"discounted_cash":123.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0465-15","type":"NDC"}],"standard_charges":[{"gross_charge":59.76,"discounted_cash":59.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308-152-15","type":"NDC"}],"standard_charges":[{"gross_charge":35.28,"discounted_cash":35.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX CREA [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0150-60","type":"NDC"}],"standard_charges":[{"gross_charge":582.11,"discounted_cash":582.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX CREA [5754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0150-15","type":"NDC"}],"standard_charges":[{"gross_charge":159.75,"discounted_cash":159.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 500000 UNITS PO TABS [5752]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-051-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000000 UNITS"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500000 UNITS"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-9988-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-504-47","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-008-02","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60432-537-60","type":"NDC"}],"standard_charges":[{"gross_charge":75.96,"discounted_cash":75.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-1045-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1045-16","type":"NDC"}],"standard_charges":[{"gross_charge":173.12,"discounted_cash":173.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP [5751]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0868-16","type":"NDC"}],"standard_charges":[{"gross_charge":181.64,"discounted_cash":181.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-306-15","type":"NDC"}],"standard_charges":[{"gross_charge":114.66,"discounted_cash":114.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-370-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.4,"discounted_cash":41.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 G"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD [39136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16714-769-03","type":"NDC"}],"standard_charges":[{"gross_charge":535.88,"discounted_cash":535.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS [5595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-604-00","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS [5595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-385-00","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NEOMYCIN SULFATE 500 MG PO TABS [5472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39822-0310-5","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEOMYCIN SULFATE 500 MG PO TABS [5472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-1177-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEOMYCIN SULFATE 500 MG PO TABS [5472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"39822-0310-7","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEFAZODONE HCL 50 MG PO TABS [21492]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7178-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS [89284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-291-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NEOMYCIN-BACITRACIN ZN-POLYMYX 5-400-10000 OP OINT [38701]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-235-35","type":"NDC"}],"standard_charges":[{"gross_charge":235.44,"discounted_cash":235.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN [122585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6149-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"NEOMYCIN-POLYMYXIN-PRAMOXINE 1 % EX CREA [19880]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0081-0737-94","type":"NDC"}],"standard_charges":[{"gross_charge":7.28,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 G"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP [28810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-645-11","type":"NDC"}],"standard_charges":[{"gross_charge":222.18,"discounted_cash":222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP [28810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-635-62","type":"NDC"}],"standard_charges":[{"gross_charge":207.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN [5474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-790-62","type":"NDC"}],"standard_charges":[{"gross_charge":285.12,"discounted_cash":285.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP [106248]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-630-06","type":"NDC"}],"standard_charges":[{"gross_charge":93.48,"discounted_cash":93.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT [106249]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-795-35","type":"NDC"}],"standard_charges":[{"gross_charge":43.33,"discounted_cash":43.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP [10708]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61919-167-05","type":"NDC"}],"standard_charges":[{"gross_charge":77.04,"discounted_cash":77.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP [10708]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-830-60","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 0.1 % OP SUSP [10708]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0998-0630-06","type":"NDC"}],"standard_charges":[{"gross_charge":679.44,"discounted_cash":679.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-BACITRACIN 3.5-5000-400 EX OINT WR [40838078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70000-0094-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 G"}]},{"description":"NEOMYCIN-POLYMYXIN-BACITRACIN 3.5-5000-400 EX OINT WR [40838078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47682-223-35","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NEOMYCIN-POLYMYXIN-BACITRACIN 3.5-5000-400 EX OINT WR [40838078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-143-70","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NEOMYCIN-POLYMYXIN-BACITRACIN 3.5-5000-400 EX OINT WR [40838078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-8805-67","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"NEOMYCIN-POLYMYXIN B GU 40-200000 IR SOLN [70678]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"39822-1201-2","type":"NDC"}],"standard_charges":[{"gross_charge":72.49,"discounted_cash":72.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS [89284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-291-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS [89284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-392-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NAPROXEN 250 MG PO TABS [5391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NAPROXEN 250 MG PO TABS [5391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-188-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 375 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NALTREXONE HCL 50 MG PO TABS [10685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-853-62","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NALTREXONE HCL 50 MG PO TABS [10685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-081-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NATAMYCIN 5 % OP SUSP [10692]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0645-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":13.24,"discounted_cash":13.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"NATEGLINIDE 120 MG PO TABS [29438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49884-985-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS [89284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-525-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS [89284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-525-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NEBIVOLOL HCL 5 MG PO TABS [89284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1405-30","type":"NDC"}],"standard_charges":[{"gross_charge":69.38,"discounted_cash":69.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":17.35,"discounted_cash":17.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":34.69,"discounted_cash":34.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"NEBIVOLOL HCL 20 MG PO TABS [97266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1420-30","type":"NDC"}],"standard_charges":[{"gross_charge":28.85,"discounted_cash":28.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":57.7,"discounted_cash":57.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"NATEGLINIDE 120 MG PO TABS [29438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382-722-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIFEDIPINE ER OSMOTIC RELEASE 90 MG PO TB24 [27660]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-009-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 [27659]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-109-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24 [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-108-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24 [28643]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-108-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 MG"}]},{"description":"NIFEDIPINE 10 MG PO CAPS [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69315-211-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NIFEDIPINE 10 MG PO CAPS [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-425-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NIFEDIPINE 10 MG PO CAPS [5558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-194-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"NIMODIPINE 30 MG PO CAPS [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-512-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NIMODIPINE 30 MG PO CAPS [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-209-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS [5595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-390-31","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NITAZOXANIDE 500 MG PO TABS [39254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67546-111-12","type":"NDC"}],"standard_charges":[{"gross_charge":804.89,"discounted_cash":804.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NITAZOXANIDE 500 MG PO TABS [39254]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-526-60","type":"NDC"}],"standard_charges":[{"gross_charge":418.83,"discounted_cash":418.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NISOLDIPINE ER 8.5 MG PO TB24 [91078]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-472-02","type":"NDC"}],"standard_charges":[{"gross_charge":48.63,"discounted_cash":48.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 MG"},{"gross_charge":72.94,"discounted_cash":72.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25.5 MG"},{"gross_charge":97.25,"discounted_cash":97.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 MG"},{"gross_charge":24.32,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.5 MG"}]},{"description":"NIRSEVIMAB-ALIP 50 MG/0.5ML IM SOSY [152158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-575-00","type":"NDC"}],"standard_charges":[{"gross_charge":2925.11,"discounted_cash":2925.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"NIRSEVIMAB-ALIP 100 MG/ML IM SOSY 200 MG DOSE [4082152159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"49281-574-88","type":"NDC"}],"standard_charges":[{"gross_charge":2925.11,"discounted_cash":2925.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":5850.22,"discounted_cash":5850.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"NIMODIPINE 30 MG PO CAPS [10722]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-209-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"NICOTINE POLACRILEX 4 MG MT LOZG [34770]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-177-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR [27181]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-539-81","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"NIACIN 500 MG PO TABS [5542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-4078-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"NEVIRAPINE 50 MG/5ML PO SUSP [24119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-057-24","type":"NDC"}],"standard_charges":[{"gross_charge":67.2,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"NETARSUDIL-LATANOPROST 0.02-0.005 % OP SOLN [139527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70727-529-25","type":"NDC"}],"standard_charges":[{"gross_charge":1795.36,"discounted_cash":1795.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"NEPHRO-VITE 0.8 MG PO TABS [5495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1415-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"NEPAFENAC 0.1 % OP SUSP [42486]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0078-0778-03","type":"NDC"}],"standard_charges":[{"gross_charge":1946.04,"discounted_cash":1946.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"NEPAFENAC 0.1 % OP SUSP [42486]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0002-03","type":"NDC"}],"standard_charges":[{"gross_charge":1704.77,"discounted_cash":1704.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN [122585]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-415-36","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN [12370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9542-10","type":"NDC"}],"standard_charges":[{"gross_charge":84.1,"discounted_cash":84.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NIFEDIPINE 0.3%-LIDOCAINE 1.5% CREAM [4085558]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999-194-01","type":"NDC"}],"standard_charges":[{"gross_charge":447.22,"discounted_cash":447.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN [12370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9689-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.72,"discounted_cash":121.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NICARDIPINE HCL 20 MG PO CAPS [10712]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1020-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"NICOTINE POLACRILEX 4 MG MT GUM LMC FOUNDATION [4082010718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-598-71","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NICOTINE POLACRILEX 4 MG MT GUM [10718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-3030-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"NICOTINE 7 MG/24HR TD PT24 [27860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-354-74","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"NICOTINE 21 MG/24HR TD PT24 [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-434-91","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"NICOTINE 21 MG/24HR TD PT24 [27863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-7063-0","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"NICOTINE 14 MG/24HR TD PT24 [27862]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-352-74","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN [142709]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9633-10","type":"NDC"}],"standard_charges":[{"gross_charge":275.2,"discounted_cash":275.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN [142709]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9633-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE HCL IN NACL 20-0.9 MG/200ML-% IV SOLN [142708]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9634-01","type":"NDC"}],"standard_charges":[{"gross_charge":180.13,"discounted_cash":180.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE HCL IN NACL 20-0.86 MG/200ML-% IV SOLN [94219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43066-026-10","type":"NDC"}],"standard_charges":[{"gross_charge":248.8,"discounted_cash":248.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"NICARDIPINE HCL IN NACL 20-0.86 MG/200ML-% IV SOLN [94219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43066-009-10","type":"NDC"}],"standard_charges":[{"gross_charge":246.4,"discounted_cash":246.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2359","type":"HCPCS"},{"code":"0002-7597-01","type":"NDC"}],"standard_charges":[{"gross_charge":322.18,"discounted_cash":322.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":322.18,"discounted_cash":322.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHAZOLAMIDE 25 MG PO TABS [4961]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-240-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METHADONE HCL 10 MG/ML PO CONC [15996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0391-68","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE HCL 10 MG/ML IJ SOLN [10546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"67457-217-20","type":"NDC"}],"standard_charges":[{"gross_charge":1356.16,"discounted_cash":1356.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"METHADONE HCL 10 MG PO TABS [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6530-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE HCL 10 MG PO TABS [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-5771-62","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHADONE HCL 10 MG PO TABS [4953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0710-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHENAMINE HIPPURATE 1 G PO TABS [10549]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-577-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"METHENAMINE HIPPURATE 1 G PO TABS [10549]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-142-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"METHIMAZOLE 5 MG PO TABS [10553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-669-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHIMAZOLE 5 MG PO TABS [10553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-357-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHIMAZOLE 5 MG PO TABS [10553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-357-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHIMAZOLE 5 MG PO TABS [10553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-640-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHACHOLINE CHLORIDE IN KIT - 0 MG/ML [4082143670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"99999-541-99","type":"NDC"}],"standard_charges":[{"gross_charge":760.1,"discounted_cash":760.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"METHACHOLINE CHLORIDE IN KIT - 0 MG/ML [4082143670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"69374-541-03","type":"NDC"}],"standard_charges":[{"gross_charge":866.7,"discounted_cash":866.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-561-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":20.83,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-008-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":20.83,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60429-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":20.83,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-397-53","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":20.83,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-397-51","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":20.83,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METFORMIN HCL 500 MG PO TABS [10544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-063-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":20.83,"discounted_cash":20.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METHACHOLINE CHLORIDE IN KIT - 0 MG/ML [4082143670]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"64281-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":866.7,"discounted_cash":866.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"METHACHOLINE CHLORIDE 100 MG IN SOLR [27032]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7674","type":"HCPCS"},{"code":"64281-100-06","type":"NDC"}],"standard_charges":[{"gross_charge":563.08,"discounted_cash":563.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METFORMIN HCL ER 750 MG PO TB24 [35771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN HCL ER 750 MG PO TB24 [35771]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-143-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN HCL ER 500 MG PO TB24 [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-491-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN HCL ER 500 MG PO TB24 [28995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-142-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METFORMIN HCL 850 MG PO TABS [14719]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7163-61","type":"NDC"}],"standard_charges":[{"gross_charge":14.42,"discounted_cash":14.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 MG"}]},{"description":"METHIMAZOLE 5 MG PO TABS [10553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-669-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS [13594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"69238-1423-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":85.75,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":110.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS [13594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"0555-0572-02","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS [13594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0555-0572-02","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":85.75,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":110.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METHOTREXATE SODIUM 1 G IJ SOLR [4975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"0143-9830-01","type":"NDC"}],"standard_charges":[{"gross_charge":74.44,"discounted_cash":74.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IM INJECTION [4084089001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-3671-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.56,"discounted_cash":53.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":58.33,"discounted_cash":58.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":67.88,"discounted_cash":67.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN [91651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649-551-07","type":"NDC"}],"standard_charges":[{"gross_charge":825.13,"discounted_cash":825.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":550.09,"discounted_cash":550.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN [91651]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649-551-03","type":"NDC"}],"standard_charges":[{"gross_charge":776.92,"discounted_cash":776.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":517.95,"discounted_cash":517.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN [10571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"51991-144-99","type":"NDC"}],"standard_charges":[{"gross_charge":90.43,"discounted_cash":90.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN [10571]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0740-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.07,"discounted_cash":117.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG PO TABS [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69238-1605-8","type":"NDC"}],"standard_charges":[{"gross_charge":96.36,"discounted_cash":96.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"METHYLERGONOVINE MALEATE 0.2 MG PO TABS [10572]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0054-0639-13","type":"NDC"}],"standard_charges":[{"gross_charge":317.83,"discounted_cash":317.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [131827]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"0517-0374-05","type":"NDC"}],"standard_charges":[{"gross_charge":622.84,"discounted_cash":622.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN [131827]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"0517-0374-01","type":"NDC"}],"standard_charges":[{"gross_charge":1005.64,"discounted_cash":1005.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % IV SOLN [149053]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-147-01","type":"NDC"}],"standard_charges":[{"gross_charge":911.92,"discounted_cash":911.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHOTREXATE SODIUM 2.5 MG PO TABS [13594]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8610","type":"HCPCS"},{"code":"69238-1423-1","type":"NDC"}],"standard_charges":[{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":147.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IM INJECTION [4084089001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9519-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.6,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.99,"discounted_cash":42.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN [127806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":65.84,"discounted_cash":65.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN [127806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-273-00","type":"NDC"}],"standard_charges":[{"gross_charge":56.08,"discounted_cash":56.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN [127806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-778-21","type":"NDC"}],"standard_charges":[{"gross_charge":65.18,"discounted_cash":65.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN [127806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-778-10","type":"NDC"}],"standard_charges":[{"gross_charge":68.98,"discounted_cash":68.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN [127806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-223-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.56,"discounted_cash":44.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHIMAZOLE 5 MG PO TABS [10553]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN [127806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-101-25","type":"NDC"}],"standard_charges":[{"gross_charge":53.38,"discounted_cash":53.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN [127806]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-716-11","type":"NDC"}],"standard_charges":[{"gross_charge":60.15,"discounted_cash":60.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IM INJECTION [4084089001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9519-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.4,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.6,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":43.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"METHOHEXITAL SODIUM 0.5 G IJ SOLR [70545]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42023-105-01","type":"NDC"}],"standard_charges":[{"gross_charge":321.61,"discounted_cash":321.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":321.61,"discounted_cash":321.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METHOCARBAMOL 750 MG PO TABS [4972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-124-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 750 MG PO TABS [4972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70010-770-05","type":"NDC"}],"standard_charges":[{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METHOCARBAMOL 500 MG PO TABS [4971]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-405-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METAXALONE 800 MG PO TABS [33963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55111-650-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEMANTINE HCL ER 14 MG PO CP24 [121524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-055-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE HCL ER 14 MG PO CP24 [121524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-783-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE HCL ER 14 MG PO CP24 [121524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6736-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEMANTINE HCL 5 MG PO TABS [37170]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-297-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE HCL 10 MG PO TABS [36966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72578-004-14","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEMANTINE HCL ER 7 MG PO CP24 [121523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-782-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6052-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.06,"discounted_cash":44.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":88.12,"discounted_cash":88.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1362-11","type":"NDC"}],"standard_charges":[{"gross_charge":63.61,"discounted_cash":63.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":127.21,"discounted_cash":127.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1176-30","type":"NDC"}],"standard_charges":[{"gross_charge":58.73,"discounted_cash":58.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":117.46,"discounted_cash":117.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1176-03","type":"NDC"}],"standard_charges":[{"gross_charge":58.23,"discounted_cash":58.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":116.45,"discounted_cash":116.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPERIDINE HCL 100 MG/ML IJ SOLN [4902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1180-69","type":"NDC"}],"standard_charges":[{"gross_charge":58.17,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MEPERIDINE HCL 100 MG/ML IJ SOLN [4902]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1180-59","type":"NDC"}],"standard_charges":[{"gross_charge":58.51,"discounted_cash":58.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY [127386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-976-20","type":"NDC"}],"standard_charges":[{"gross_charge":1069.18,"discounted_cash":1069.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY [127386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-976-02","type":"NDC"}],"standard_charges":[{"gross_charge":892.28,"discounted_cash":892.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR [101034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-958-01","type":"NDC"}],"standard_charges":[{"gross_charge":605.22,"discounted_cash":605.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR [101034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-955-09","type":"NDC"}],"standard_charges":[{"gross_charge":699.25,"discounted_cash":699.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MELOXICAM 7.5 MG PO TABS [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382-050-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELOXICAM 7.5 MG PO TABS [20566]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68382-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MELATONIN 5 MG PO TABS [17427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31604-02743","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":14.7,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS [4855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0055-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS [4855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0872-02","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY [132109]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121-1480-1","type":"NDC"}],"standard_charges":[{"gross_charge":443.27,"discounted_cash":443.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY [132109]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"0009-7376-11","type":"NDC"}],"standard_charges":[{"gross_charge":1234.53,"discounted_cash":1234.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121-1467-2","type":"NDC"}],"standard_charges":[{"gross_charge":188.71,"discounted_cash":188.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"67457-887-01","type":"NDC"}],"standard_charges":[{"gross_charge":77.19,"discounted_cash":77.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"67457-887-00","type":"NDC"}],"standard_charges":[{"gross_charge":138.03,"discounted_cash":138.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993-370-83","type":"NDC"}],"standard_charges":[{"gross_charge":245.66,"discounted_cash":245.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"55150-329-01","type":"NDC"}],"standard_charges":[{"gross_charge":172.86,"discounted_cash":172.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"50090-0883-0","type":"NDC"}],"standard_charges":[{"gross_charge":136.84,"discounted_cash":136.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"0548-5410-00","type":"NDC"}],"standard_charges":[{"gross_charge":145.7,"discounted_cash":145.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP [19736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"0009-0746-30","type":"NDC"}],"standard_charges":[{"gross_charge":339.58,"discounted_cash":339.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM INJ WR [40819736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"59762-4537-2","type":"NDC"}],"standard_charges":[{"gross_charge":442.57,"discounted_cash":442.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6052-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEGESTROL ACETATE 20 MG PO TABS [4870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0606-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MELATONIN 3 MG PO TABS [16830]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31604-02742","type":"NDC"}],"standard_charges":[{"gross_charge":40.84,"discounted_cash":40.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP [10521]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-063-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MEGESTROL ACETATE 40 MG PO TABS [4871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-159-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MEGESTROL ACETATE 40 MG PO TABS [4871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7236-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MEGESTROL ACETATE 40 MG PO TABS [4871]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0607-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN [4904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1178-03","type":"NDC"}],"standard_charges":[{"gross_charge":60.67,"discounted_cash":60.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":60.67,"discounted_cash":60.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEROPENEM 500 MG/10ML IV (WET SOLR VIAL) [150453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150-207-20","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 500 MG/10ML IV (WET SOLR VIAL) [150453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-207-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"MEROPENEM 500 MG/10ML IV (WET SOLR VIAL) [150453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-1390-51","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 500 MG/10ML IV (WET SOLR VIAL) [150453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1390-51","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"MEROPENEM 500 MG IV SOLR [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-0222-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":168.0,"discounted_cash":168.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEROPENEM 500 MG IV SOLR [17379]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-0222-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"MEROPENEM 1 G/20ML IV (WET SOLR VIAL) [150454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-1391-22","type":"NDC"}],"standard_charges":[{"gross_charge":44.82,"discounted_cash":44.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":89.63,"discounted_cash":89.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MESALAMINE 1.2 G PO TBEC [78310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63304-175-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 G"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.8 G"}]},{"description":"MESALAMINE ER 500 MG PO CPCR [39575]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-191-12","type":"NDC"}],"standard_charges":[{"gross_charge":44.81,"discounted_cash":44.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":22.41,"discounted_cash":22.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE ER 250 MG PO CPCR [10533]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"54092-189-81","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MESALAMINE ER 0.375 G PO CP24 [95687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70748-214-16","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"MESALAMINE ER 0.375 G PO CP24 [95687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-113-20","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"MESALAMINE ER 0.375 G PO CP24 [95687]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1375-78","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"MESALAMINE 400 MG PO CPDR [120648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-5907-86","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MESALAMINE 400 MG PO CPDR [120648]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-5853-18","type":"NDC"}],"standard_charges":[{"gross_charge":23.19,"discounted_cash":23.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":46.38,"discounted_cash":46.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 800 MG"}]},{"description":"MESALAMINE 4 G RE ENEM [10535]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-098-51","type":"NDC"}],"standard_charges":[{"gross_charge":70.2,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"MESALAMINE 4 G RE ENEM [10535]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-098-46","type":"NDC"}],"standard_charges":[{"gross_charge":89.71,"discounted_cash":89.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"MESALAMINE 1000 MG RE SUPP [40369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58914-501-56","type":"NDC"}],"standard_charges":[{"gross_charge":141.04,"discounted_cash":141.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":70.52,"discounted_cash":70.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"MEROPENEM 1 G/20ML IV (WET SOLR VIAL) [150454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1391-22","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"MEROPENEM 1 G IV SOLR [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"0409-3412-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.2,"discounted_cash":50.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":100.39,"discounted_cash":100.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"MEPIVACAINE HCL (PF) 2 % IJ SOLN [105638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-294-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":49.26,"discounted_cash":49.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":65.68,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":82.1,"discounted_cash":82.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":98.52,"discounted_cash":98.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MEPIVACAINE HCL (PF) 1.5 % IJ SOLN [146525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-293-37","type":"NDC"}],"standard_charges":[{"gross_charge":74.14,"discounted_cash":74.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MEPIVACAINE HCL (PF) 1.5 % IJ SOLN [146525]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-293-01","type":"NDC"}],"standard_charges":[{"gross_charge":74.68,"discounted_cash":74.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MEPERIDINE HCL 75 MG/ML IJ SOLN [4905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1179-30","type":"NDC"}],"standard_charges":[{"gross_charge":58.17,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":58.17,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":58.17,"discounted_cash":58.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEPERIDINE HCL 75 MG/ML IJ SOLN [4905]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1179-03","type":"NDC"}],"standard_charges":[{"gross_charge":58.42,"discounted_cash":58.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":58.42,"discounted_cash":58.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":58.42,"discounted_cash":58.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN [4904]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6053-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPIVACAINE HCL (PF) 2 % IJ SOLN [105638]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-294-27","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":49.26,"discounted_cash":49.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":65.68,"discounted_cash":65.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":82.1,"discounted_cash":82.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"},{"gross_charge":98.52,"discounted_cash":98.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MEROPENEM 1 G IV SOLR [17380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3412-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"}]},{"description":"MERCAPTOPURINE 50 MG PO TABS [10531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3547-52","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MERCAPTOPURINE 50 MG PO TABS [10531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3547-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MERCAPTOPURINE 50 MG PO TABS [10531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-4581-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MEPOLIZUMAB 100 MG SC SOLR [129685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2182","type":"HCPCS"},{"code":"0173-0881-01","type":"NDC"}],"standard_charges":[{"gross_charge":11501.52,"discounted_cash":11501.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPHENIDATE HCL 5 MG PO TABS [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MICONAZOLE NITRATE 2 % EX CREA [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2001-2","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"MICONAZOLE NITRATE 2 % EX CREA [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0735-56","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"MICONAZOLE NITRATE 2 % EX CREA [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0472-0735-14","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 G"}]},{"description":"MICONAZOLE NITRATE 2 % EX AERP [5038]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11017-41025","type":"NDC"}],"standard_charges":[{"gross_charge":12.95,"discounted_cash":12.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 G"}]},{"description":"MICAFUNGIN SODIUM 100 MG/5ML IV (WET SOLR VIAL) [150455]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2248","type":"HCPCS"},{"code":"63323-729-10","type":"NDC"}],"standard_charges":[{"gross_charge":205.94,"discounted_cash":205.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":308.91,"discounted_cash":308.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"MICONAZOLE NITRATE 2 % EX CREA [5039]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-481-45","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 G"}]},{"description":"MEXILETINE HCL 200 MG PO CAPS [10596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-4108-37","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"MEXILETINE HCL 150 MG PO CAPS [10595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-955-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":20.42,"discounted_cash":20.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"MICONAZOLE NITRATE 2 % VA CREA [5040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7734-45","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"MICONAZOLE NITRATE 2 % VA CREA [5040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-590-29","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-600-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDAZOLAM HCL 50 MG/10ML IJ SOLN [93523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70860-601-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN [93518]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6059-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP [24176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-7001-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP [24176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0150-04","type":"NDC"}],"standard_charges":[{"gross_charge":262.8,"discounted_cash":262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP [24176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3566-99","type":"NDC"}],"standard_charges":[{"gross_charge":252.76,"discounted_cash":252.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN [40872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-600-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":105.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEXILETINE HCL 150 MG PO CAPS [10595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-8739-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"METYRAPONE 250 MG PO CAPS [21867]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76336-455-18","type":"NDC"}],"standard_charges":[{"gross_charge":72.01,"discounted_cash":72.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":216.03,"discounted_cash":216.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL [19741]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0713-0637-37","type":"NDC"}],"standard_charges":[{"gross_charge":840.51,"discounted_cash":840.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL [19741]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0168-0275-45","type":"NDC"}],"standard_charges":[{"gross_charge":699.84,"discounted_cash":699.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"METRONIDAZOLE 0.75 % EX CREA [19805]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0168-0323-46","type":"NDC"}],"standard_charges":[{"gross_charge":400.68,"discounted_cash":400.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"METOPROLOL TARTRATE 50 MG PO TABS [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-477-58","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 50 MG PO TABS [5009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-477-52","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 5 MG/5ML IV SOLN [92079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1778-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-112-91","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL [19741]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-4116-6","type":"NDC"}],"standard_charges":[{"gross_charge":88.56,"discounted_cash":88.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 G"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN [145054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9380-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL [10592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-139-70","type":"NDC"}],"standard_charges":[{"gross_charge":164.23,"discounted_cash":164.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 G"}]},{"description":"METRONIDAZOLE 1 % EX GEL [41899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51672-4215-3","type":"NDC"}],"standard_charges":[{"gross_charge":384.12,"discounted_cash":384.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN [147757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"47335-993-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN [147757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"25021-131-82","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN [147757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7811-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN [147757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0338-9541-24","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG PO TABS [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-365-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG PO TABS [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-334-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG PO TABS [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-334-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 500 MG PO TABS [5016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-227-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 250 MG PO TABS [5015]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-333-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METRONIDAZOLE 0.75 % VA GEL [10592]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68462-184-49","type":"NDC"}],"standard_charges":[{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 G"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN [145054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9380-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN [145054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-611-01","type":"NDC"}],"standard_charges":[{"gross_charge":188.2,"discounted_cash":188.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN [145054]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70092-1418-36","type":"NDC"}],"standard_charges":[{"gross_charge":139.3,"discounted_cash":139.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIRABEGRON ER 25 MG PO TB24 [117479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1159-9","type":"NDC"}],"standard_charges":[{"gross_charge":42.89,"discounted_cash":42.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":85.78,"discounted_cash":85.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MIRABEGRON ER 25 MG PO TB24 [117479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-151-09","type":"NDC"}],"standard_charges":[{"gross_charge":70.34,"discounted_cash":70.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":140.68,"discounted_cash":140.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MIRABEGRON ER 25 MG PO TB24 [117479]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0469-2601-30","type":"NDC"}],"standard_charges":[{"gross_charge":90.72,"discounted_cash":90.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":181.44,"discounted_cash":181.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MINOXIDIL 2.5 MG PO TABS [5115]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5642-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOXIDIL 10 MG PO TABS [5114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-257-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MINOXIDIL 10 MG PO TABS [5114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5643-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIRTAZAPINE 15 MG PO TABS [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-499-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MINOCYCLINE HCL 100 MG PO CAPS [5110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63304-696-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"MIRTAZAPINE 45 MG PO TABS [24945]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3545-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG PO TBDP [29531]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-011-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"MIRTAZAPINE 15 MG PO TABS [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0247-8","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"MIRTAZAPINE 15 MG PO TABS [17466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0247-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-506-58","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MINOCYCLINE HCL 100 MG PO CAPS [5110]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0591-5695-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"MINERAL OIL PO OIL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-3000-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV SOLN [123599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9326-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.52,"discounted_cash":54.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MILNACIPRAN HCL 50 MG PO TABS [97089]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-1550-60","type":"NDC"}],"standard_charges":[{"gross_charge":100.89,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":50.45,"discounted_cash":50.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":50.45,"discounted_cash":50.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":50.45,"discounted_cash":50.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"MILK AND MOLASSES ENEMA [4081129]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-2005-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.5,"discounted_cash":54.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"MIDODRINE HCL 5 MG PO TABS [10610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-849-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE HCL 2.5 MG PO TABS [10609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-1320-1","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MIDODRINE HCL 10 MG PO TABS [33083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-1325-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV SOLN [123599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-0212-02","type":"NDC"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV SOLN [123599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-808-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.65,"discounted_cash":51.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20 MG/100ML IV SOLN [408409123596]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9719-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MINERAL OIL PO OIL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-395-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MINERAL OIL PO OIL [5086]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-1110-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"MINERAL OIL LIGHT N/A OIL [27386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63323-254-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [135422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2776-23","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [135422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2045-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [135422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0338-6010-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN [135422]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9719-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE LACTATE 20 MG/20ML IV SOLN [123599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70069-808-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.36,"discounted_cash":49.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-506-52","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR [10578]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0143-9754-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.53,"discounted_cash":73.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR [150704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0039-06","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":53.8,"discounted_cash":53.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 40 MG IJ SOLR [150704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0009-0039-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":54.43,"discounted_cash":54.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR [150705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0047-04","type":"NDC"}],"standard_charges":[{"gross_charge":70.83,"discounted_cash":70.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 2000 MG IJ SOLR [10579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0850-01","type":"NDC"}],"standard_charges":[{"gross_charge":554.08,"discounted_cash":554.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 MG"}]},{"description":"METHYLPREDNISOLONE NA SUC (PF) 125 MG IJ SOLR [150705]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0009-0047-03","type":"NDC"}],"standard_charges":[{"gross_charge":48.41,"discounted_cash":48.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"71283-0634-2","type":"NDC"}],"standard_charges":[{"gross_charge":75.32,"discounted_cash":75.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":50.21,"discounted_cash":50.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"62295-3119-1","type":"NDC"}],"standard_charges":[{"gross_charge":114.73,"discounted_cash":114.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":76.49,"discounted_cash":76.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"60219-1574-5","type":"NDC"}],"standard_charges":[{"gross_charge":93.46,"discounted_cash":93.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":62.31,"discounted_cash":62.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR [10581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"0143-9850-01","type":"NDC"}],"standard_charges":[{"gross_charge":150.32,"discounted_cash":150.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR [10581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2919","type":"HCPCS"},{"code":"43598-128-11","type":"NDC"}],"standard_charges":[{"gross_charge":116.1,"discounted_cash":116.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"METOCLOPRAMIDE HCL 10 MG PO TABS [5005]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2203-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3414-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3414-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/5ML PO SOLN [77725]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0121-0576-16","type":"NDC"}],"standard_charges":[{"gross_charge":85.14,"discounted_cash":85.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG PO TBDP [100202]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-581-31","type":"NDC"}],"standard_charges":[{"gross_charge":75.89,"discounted_cash":75.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":37.95,"discounted_cash":37.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG PO TABS [5006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-2204-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN [77710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-031-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN [77710]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1576-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":18.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP [4996]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"60219-1574-1","type":"NDC"}],"standard_charges":[{"gross_charge":93.55,"discounted_cash":93.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":62.37,"discounted_cash":62.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG PO TABS [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-557-00","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG PO TABS [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-001-06","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPHENIDATE HCL 5 MG PO TABS [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-228-88","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPHENIDATE HCL 5 MG PO TABS [4988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METHYLPREDNISOLONE 4 MG PO TABS [4993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-916-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121-1573-5","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.72,"discounted_cash":49.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121-1573-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.72,"discounted_cash":49.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"60219-1573-5","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.72,"discounted_cash":49.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP [4995]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"60219-1573-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.72,"discounted_cash":49.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-5255-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOPROLOL TARTRATE 100 MG PO TABS [5008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0047-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TB24 [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72516-031-50","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TB24 [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72516-031-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TB24 [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-357-00","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TB24 [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-467-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 100 MG PO TABS [5008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-100-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 25 MG PO TABS [37637]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0018-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 100 MG PO TABS [5008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-064-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL TARTRATE 100 MG PO TABS [5008]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-167-52","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TB24 [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-616-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOLAZONE 2.5 MG PO TABS [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-536-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-240-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-5255-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-5255-15","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN [5002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-5255-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOLAZONE 2.5 MG PO TABS [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-536-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOLAZONE 2.5 MG PO TABS [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-052-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"METOPROLOL SUCCINATE ER 50 MG PO TB24 [30070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-038-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOPROLOL SUCCINATE ER 25 MG PO TB24 [29858]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-037-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"METOLAZONE 2.5 MG PO TABS [10587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM INJ WR [40819736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"0548-5400-00","type":"NDC"}],"standard_charges":[{"gross_charge":319.62,"discounted_cash":319.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2359","type":"HCPCS"},{"code":"0517-0955-01","type":"NDC"}],"standard_charges":[{"gross_charge":245.47,"discounted_cash":245.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":245.47,"discounted_cash":245.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42494-416-01","type":"NDC"}],"standard_charges":[{"gross_charge":213.92,"discounted_cash":213.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":278.1,"discounted_cash":278.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 130 MG"},{"gross_charge":427.84,"discounted_cash":427.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENOBARBITAL 97.2 MG PO TABS [6220]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-668-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 97.2 MG PO TABS [6220]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5168-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 64.8 MG PO TABS [6219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826-141-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.8 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 64.8 MG PO TABS [6219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367-213-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.8 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN [6221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42494-416-25","type":"NDC"}],"standard_charges":[{"gross_charge":170.24,"discounted_cash":170.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":221.31,"discounted_cash":221.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 130 MG"},{"gross_charge":340.47,"discounted_cash":340.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENTOLAMINE MESYLATE 5 MG IJ SOLR [10947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9564-01","type":"NDC"}],"standard_charges":[{"gross_charge":3597.7,"discounted_cash":3597.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3597.7,"discounted_cash":3597.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1798.85,"discounted_cash":1798.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENTERMINE HCL 30 MG PO CAPS [6232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11534-176-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18.75 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"}]},{"description":"PHENOL 89 % N/A LIQD [41319]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"38779-1938-8","type":"NDC"}],"standard_charges":[{"gross_charge":155.82,"discounted_cash":155.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"PHENOL 89 % EX SWAB [39587]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0884-6297-30","type":"NDC"}],"standard_charges":[{"gross_charge":26.9,"discounted_cash":26.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PHENOL 1.4 % MT LIQD [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6305-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOL 1.4 % MT LIQD [36976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1228-58","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-136-10","type":"NDC"}],"standard_charges":[{"gross_charge":244.81,"discounted_cash":244.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 130 MG"},{"gross_charge":122.41,"discounted_cash":122.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 65 MG"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN [6224]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-136-01","type":"NDC"}],"standard_charges":[{"gross_charge":259.21,"discounted_cash":259.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 130 MG"},{"gross_charge":129.61,"discounted_cash":129.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 65 MG"}]},{"description":"PHENOBARBITAL 64.8 MG PO TABS [6219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13517-627-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.8 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 32.4 MG PO TABS [6217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5166-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 20 MG/5ML PO ELIX [6212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-675-16","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":96.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PHENOBARBITAL 20 MG/5ML PO ELIX [6212]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1508-58","type":"NDC"}],"standard_charges":[{"gross_charge":309.35,"discounted_cash":309.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"PHENELZINE SULFATE 15 MG PO TABS [10933]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-0119-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"PHENAZOPYRIDINE HCL 200 MG PO TABS [6194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293-811-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENAZOPYRIDINE HCL 200 MG PO TABS [6194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293-802-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENAZOPYRIDINE HCL 200 MG PO TABS [6194]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42937-702-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENAZOPYRIDINE HCL 100 MG PO TABS [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"75826-114-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENOBARBITAL 32.4 MG PO TABS [6217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6575-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 64.8 MG PO TABS [6219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-5167-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 62.8 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 32.4 MG PO TABS [6217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13517-111-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENOBARBITAL 32.4 MG PO TABS [6217]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6575-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32.4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64.8 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 97.2 MG"}]},{"description":"PHENTOLAMINE MESYLATE 5 MG IJ SOLR [10947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9564-10","type":"NDC"}],"standard_charges":[{"gross_charge":3597.7,"discounted_cash":3597.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":3597.7,"discounted_cash":3597.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1798.85,"discounted_cash":1798.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENYTOIN 100 MG/4ML PO SUSP [37993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0892-63","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN 100 MG/4ML PO SUSP [37993]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0892-50","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYLEPHRINE-MINERAL OIL-PET 0.25-14-74.9 % RE OINT [124146]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"46122-677-46","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"PHENYLEPHRINE-DM 2.5-5 MG/5ML PO SYRP [94524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0067-8105-04","type":"NDC"}],"standard_charges":[{"gross_charge":27.62,"discounted_cash":27.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"PHENYLEPHRINE-DM 2.5-5 MG/5ML PO SOLN [78603]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0538-04","type":"NDC"}],"standard_charges":[{"gross_charge":33.71,"discounted_cash":33.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RE SUPP [125975]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1186-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"}]},{"description":"PHENYLEPHRINE HCL-NACL 80-0.9 MG/250ML-% IV SOLN - ANE [4084080077]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"9999-1910-10","type":"NDC"}],"standard_charges":[{"gross_charge":164.5,"discounted_cash":164.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"PHENYLEPHRINE HCL-NACL 40-0.9 MG/250ML-% IV SOLN [133499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"99999-9170-5","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"PHENYLEPHRINE HCL-NACL 20-0.9 MG/250ML-% IV SOLN [135130]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"9999-1042-05","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"PHENYLEPHRINE HCL-NACL 0.1-0.9 MG/10ML-% IV SOSY [40896242]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"9999-6003-35","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71863-202-06","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYTOIN 50 MG PO CHEW [11018]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-4146-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71863-202-06","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-2555-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-808-18","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1560-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42192-614-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN [6256]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-2555-45","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71863-202-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71863-202-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72485-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72485-506-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288-808-77","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-808-77","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"25021-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-315-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 0.5 MG/5ML IV SOLN [153092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6245-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 0.5 MG/5ML IV SOLN [153092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6245-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENTOLAMINE MESYLATE 5 MG IJ SOLR [10947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68094-101-20","type":"NDC"}],"standard_charges":[{"gross_charge":4218.64,"discounted_cash":4218.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":4218.64,"discounted_cash":4218.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":2109.32,"discounted_cash":2109.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"81284-213-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"81284-213-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"81284-213-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2372","type":"HCPCS"},{"code":"43598-172-15","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MCG"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-172-15","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL 500 MCG/ML STOCK SOLUTION [4082126758]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"9999-6142-02","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70756-629-25","type":"NDC"}],"standard_charges":[{"gross_charge":172.44,"discounted_cash":172.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-201-15","type":"NDC"}],"standard_charges":[{"gross_charge":480.6,"discounted_cash":480.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN [6246]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-201-02","type":"NDC"}],"standard_charges":[{"gross_charge":184.46,"discounted_cash":184.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PHENYLEPHRINE HCL 100 MCG/ML STOCK SOLUTION [4082126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"9999-6142-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71863-202-06","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL PRESSORS PF 0.5 MG/5ML IV SOLN [141408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71863-202-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 0.5 MG/5ML IV SOLN [153092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6245-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 0.5 MG/5ML IV SOLN [153092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0641-6245-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN [19636]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70756-614-30","type":"NDC"}],"standard_charges":[{"gross_charge":206.28,"discounted_cash":206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN [19636]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"42702-103-05","type":"NDC"}],"standard_charges":[{"gross_charge":238.89,"discounted_cash":238.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL 0.5 % NA SOLN [6244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0225-0805-47","type":"NDC"}],"standard_charges":[{"gross_charge":6.62,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN [126757]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"81284-213-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MCG"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS [6257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-808-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PHENAZOPYRIDINE HCL 100 MG PO TABS [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-681-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENAZOPYRIDINE HCL 100 MG PO TABS [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293-810-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PAROXETINE HCL 30 MG PO TABS [10856]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-156-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.07,"discounted_cash":18.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.09,"discounted_cash":24.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.12,"discounted_cash":30.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.14,"discounted_cash":36.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PAROXETINE HCL 20 MG PO TABS [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-045-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PAROXETINE HCL 20 MG PO TABS [10855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-045-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PAROXETINE HCL 10 MG/5ML PO SUSP [22959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-319-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.63,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":85.26,"discounted_cash":85.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":127.89,"discounted_cash":127.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":170.52,"discounted_cash":170.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":213.15,"discounted_cash":213.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":255.78,"discounted_cash":255.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PATIROMER SORBITEX CALCIUM 8.4 G PO PACK [129851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"53436-084-01","type":"NDC"}],"standard_charges":[{"gross_charge":511.4,"discounted_cash":511.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.8 G"},{"gross_charge":767.09,"discounted_cash":767.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25.2 G"},{"gross_charge":255.7,"discounted_cash":255.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.4 G"}]},{"description":"PASIREOTIDE DIASPARTATE 0.9 MG/ML SC SOLN [121006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55292-133-60","type":"NDC"}],"standard_charges":[{"gross_charge":1903.3,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":1903.3,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":1903.3,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"}]},{"description":"PASIREOTIDE DIASPARTATE 0.9 MG/ML SC SOLN [121006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55292-133-06","type":"NDC"}],"standard_charges":[{"gross_charge":1903.3,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":1903.3,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":1903.3,"discounted_cash":1903.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"}]},{"description":"PASIREOTIDE DIASPARTATE 0.9 MG/ML SC SOLN [121006]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0078-0635-20","type":"NDC"}],"standard_charges":[{"gross_charge":2281.76,"discounted_cash":2281.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 MG"},{"gross_charge":2281.76,"discounted_cash":2281.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MG"},{"gross_charge":2281.76,"discounted_cash":2281.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 MG"}]},{"description":"PAROXETINE HCL ER 12.5 MG PO TB24 [32631]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-1316-3","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 MG"}]},{"description":"PARICALCITOL 5 MCG/ML IV SOLN [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-380-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":50.4,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MCG"},{"gross_charge":58.8,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MCG"}]},{"description":"PARICALCITOL 5 MCG/ML IV SOLN [22960]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-380-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MCG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MCG"},{"gross_charge":50.4,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MCG"},{"gross_charge":58.8,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MCG"}]},{"description":"PARICALCITOL 1 MCG PO CAPS [41497]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49483-687-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MCG"}]},{"description":"PARAGARD INTRAUTERINE COPPER IU IUD [6040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"59365-5128-1","type":"NDC"}],"standard_charges":[{"gross_charge":5190.57,"discounted_cash":5190.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"PARAGARD INTRAUTERINE COPPER IU IUD [6040]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"51285-204-01","type":"NDC"}],"standard_charges":[{"gross_charge":5190.57,"discounted_cash":5190.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 INTRA UTERINE DEVICE"}]},{"description":"PAROMOMYCIN SULFATE 250 MG PO CAPS [10854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"23155-038-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.54,"discounted_cash":22.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":45.08,"discounted_cash":45.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":67.61,"discounted_cash":67.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"PAROMOMYCIN SULFATE 250 MG PO CAPS [10854]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"80725-250-01","type":"NDC"}],"standard_charges":[{"gross_charge":701.2,"discounted_cash":701.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1402.4,"discounted_cash":1402.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":2103.59,"discounted_cash":2103.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"PAROXETINE HCL 10 MG/5ML PO SUSP [22959]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0402-5","type":"NDC"}],"standard_charges":[{"gross_charge":54.66,"discounted_cash":54.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":109.32,"discounted_cash":109.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":163.98,"discounted_cash":163.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":218.64,"discounted_cash":218.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":273.3,"discounted_cash":273.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":327.96,"discounted_cash":327.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PAROXETINE HCL 10 MG PO TABS [16632]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-044-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"PATIROMER SORBITEX CALCIUM 8.4 G PO PACK [129851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"53436-084-30","type":"NDC"}],"standard_charges":[{"gross_charge":391.82,"discounted_cash":391.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.8 G"},{"gross_charge":587.72,"discounted_cash":587.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25.2 G"},{"gross_charge":195.91,"discounted_cash":195.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.4 G"}]},{"description":"PERINDOPRIL ERBUMINE 4 MG PO TABS [13160]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0111-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML IV SUSP [31270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"11994-011-04","type":"NDC"}],"standard_charges":[{"gross_charge":378.19,"discounted_cash":378.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"},{"gross_charge":756.37,"discounted_cash":756.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PERAMPANEL 4 MG PO TABS [124313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62856-274-30","type":"NDC"}],"standard_charges":[{"gross_charge":610.97,"discounted_cash":610.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":733.16,"discounted_cash":733.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":122.2,"discounted_cash":122.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":244.39,"discounted_cash":244.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":366.58,"discounted_cash":366.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":488.78,"discounted_cash":488.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PENTOXIFYLLINE ER 400 MG PO TBCR [21300]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-101-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"PENTOSAN POLYSULFATE SODIUM 100 MG PO CAPS [12912]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-098-01","type":"NDC"}],"standard_charges":[{"gross_charge":70.81,"discounted_cash":70.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN [6097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76478-501-50","type":"NDC"}],"standard_charges":[{"gross_charge":313.01,"discounted_cash":313.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":417.34,"discounted_cash":417.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN [6097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-676-50","type":"NDC"}],"standard_charges":[{"gross_charge":329.68,"discounted_cash":329.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":439.57,"discounted_cash":439.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PENTETATE INDIUM DISODIUM IN-111 [4089914]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"99999101410","type":"NDC"}],"standard_charges":[{"gross_charge":5812.36,"discounted_cash":5812.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"PERINDOPRIL ERBUMINE 8 MG PO TABS [13161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0112-25","type":"NDC"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":23.64,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":23.64,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PHENAZOPYRIDINE HCL 100 MG PO TABS [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51293-801-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PHENAZOPYRIDINE HCL 100 MG PO TABS [6193]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42937-701-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"PERTUZUMAB 420 MG/14ML IV SOLN [115271]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"50242-145-01","type":"NDC"}],"standard_charges":[{"gross_charge":18541.36,"discounted_cash":18541.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 ML"}]},{"description":"PERTUZ-TRASTUZ-HYALURON-ZZXF 80-40-2000 MG-MG-U/ML SC SOLN [143446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242-245-01","type":"NDC"}],"standard_charges":[{"gross_charge":45247.4,"discounted_cash":45247.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"}]},{"description":"PERTUZ-TRASTUZ-HYALURON-ZZXF 60-60-2000 MG-MG-U/ML SC SOLN [143445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242-260-01","type":"NDC"}],"standard_charges":[{"gross_charge":30178.44,"discounted_cash":30178.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"PERPHENAZINE 2 MG PO TABS [6157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-290-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"PERMETHRIN 5 % EX CREA [10917]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45802-269-37","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"PERMETHRIN 0.5 % N/A AERO [10919]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-275-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 142 G"}]},{"description":"PENTAMIDINE ISETHIONATE 300 MG IN NEBU [40827430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"13925-515-10","type":"NDC"}],"standard_charges":[{"gross_charge":648.56,"discounted_cash":648.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PENICILLIN V POTASSIUM 500 MG PO TABS [6093]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-041-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY [147693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60793-700-01","type":"NDC"}],"standard_charges":[{"gross_charge":815.64,"discounted_cash":815.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 MILLION UNITS"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY [147694]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-701-10","type":"NDC"}],"standard_charges":[{"gross_charge":2206.88,"discounted_cash":2206.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":4413.76,"discounted_cash":4413.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PEMETREXED DISODIUM 100 MG IV SOLR [89350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"68001-535-41","type":"NDC"}],"standard_charges":[{"gross_charge":1019.78,"discounted_cash":1019.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PEMETREXED DISODIUM 100 MG IV SOLR [89350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9305","type":"HCPCS"},{"code":"0002-7640-01","type":"NDC"}],"standard_charges":[{"gross_charge":5079.53,"discounted_cash":5079.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PEMBROLIZUMAB 100 MG/4ML IV SOLN [127489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"0006-3026-04","type":"NDC"}],"standard_charges":[{"gross_charge":20856.92,"discounted_cash":20856.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PEMBROLIZUMAB 100 MG/4ML IV SOLN [127489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"0006-3026-02","type":"NDC"}],"standard_charges":[{"gross_charge":21589.64,"discounted_cash":21589.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PEMBROLIZUMAB 100 MG/4ML IV SOLN [127489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"0006-3026-01","type":"NDC"}],"standard_charges":[{"gross_charge":16696.15,"discounted_cash":16696.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PEGLOTICASE 8 MG/ML IV SOLN [107664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"75987-080-10","type":"NDC"}],"standard_charges":[{"gross_charge":58184.08,"discounted_cash":58184.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY [137576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257-005-41","type":"NDC"}],"standard_charges":[{"gross_charge":6563.77,"discounted_cash":6563.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY [137576]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"67457-833-06","type":"NDC"}],"standard_charges":[{"gross_charge":6597.48,"discounted_cash":6597.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOAJ [151188]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114-120-01","type":"NDC"}],"standard_charges":[{"gross_charge":11915.72,"discounted_cash":11915.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEGFILGRASTIM ORDERABLE [4082129184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513-190-01","type":"NDC"}],"standard_charges":[{"gross_charge":16414.06,"discounted_cash":16414.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR [10839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-090-19","type":"NDC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR [10839]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10572-100-01","type":"NDC"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSY 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[147693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793-700-10","type":"NDC"}],"standard_charges":[{"gross_charge":2340.6,"discounted_cash":2340.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 MILLION UNITS"},{"gross_charge":4681.2,"discounted_cash":4681.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 MILLION UNITS"}]},{"description":"PENICILLIN V POTASSIUM 250 MG PO TABS [6092]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-040-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 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[131395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"TRIMIX","type":"HCPCS"},{"code":"99999-035-35","type":"NDC"}],"standard_charges":[{"gross_charge":891.19,"discounted_cash":891.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN [11082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0338-0695-04","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40 MEQ/100ML IV SOLN [143411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"9999-6653-06","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40 MEQ/100ML IV SOLN [143411]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0990-7116-09","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN 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[36046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0990-9257-39","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN [36046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0338-0704-34","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE ER 8 MEQ PO TBCR [12185]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-5322-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ PO TBCR [12184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-518-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MEQ"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN [36046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-683-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN [11082]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-688-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TBCR [11083]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2729-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN [134819]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"75834-280-30","type":"NDC"}],"standard_charges":[{"gross_charge":1856.34,"discounted_cash":1856.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1856.34,"discounted_cash":1856.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1856.34,"discounted_cash":1856.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":1856.34,"discounted_cash":1856.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1856.34,"discounted_cash":1856.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN [134819]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71740-112-30","type":"NDC"}],"standard_charges":[{"gross_charge":2794.32,"discounted_cash":2794.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":2794.32,"discounted_cash":2794.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":2794.32,"discounted_cash":2794.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":2794.32,"discounted_cash":2794.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":2794.32,"discounted_cash":2794.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"POTASSIUM CL IN DEXTROSE 5% 20 MEQ/L IV SOLN [9791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0264-7625-00","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1100-334 MG/5ML PO SOLN [22646]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58657-31216","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1100-334 MG/5ML PO SOLN 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[12184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4561-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MEQ"}]},{"description":"POTASSIUM CHLORIDE ER 10 MEQ PO TBCR [12184]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5316-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN [40840811076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0338-0705-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN [11076]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789-108-16","type":"NDC"}],"standard_charges":[{"gross_charge":219.4,"discounted_cash":219.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN 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[6434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-1554-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-967-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-967-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-965-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323-965-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-6653-18","type":"NDC"}],"standard_charges":[{"gross_charge":101.68,"discounted_cash":101.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1680-00","type":"NDC"}],"standard_charges":[{"gross_charge":21.87,"discounted_cash":21.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM PHOSPHATE MONOBASIC 500 MG PO TABS [11087]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0486-1111-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7461-51","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-674-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63739-973-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR [35943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0245-5319-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MEQ"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-220-52","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-220-51","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81033-220-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-628-71","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-628-44","type":"NDC"}],"standard_charges":[{"gross_charge":28.62,"discounted_cash":28.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-628-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN [76913]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-674-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MEQ"}]},{"description":"POTASSIUM PHOSPHATES 150 MMOLE/50ML IV SOLN [127800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2505-01","type":"NDC"}],"standard_charges":[{"gross_charge":309.1,"discounted_cash":309.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"POTASSIUM PHOSPHATES 150 MMOLE/50ML IV SOLN [127800]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-056-09","type":"NDC"}],"standard_charges":[{"gross_charge":616.6,"discounted_cash":616.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PRAZOSIN HCL 1 MG PO CAPS [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1101-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAVASTATIN SODIUM 80 MG PO TABS [32128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-1323-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN SODIUM 40 MG PO TABS [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-197-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN SODIUM 40 MG PO TABS [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0170-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAVASTATIN SODIUM 40 MG PO TABS [11112]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0170-7","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAZOSIN HCL 1 MG PO CAPS [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7020-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN HCL 5 MG PO CAPS [6470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-572-32","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN HCL 1 MG PO CAPS [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-996-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PRAZOSIN HCL 1 MG PO CAPS [6468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-630-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-6653-05","type":"NDC"}],"standard_charges":[{"gross_charge":44.92,"discounted_cash":44.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PRAVASTATIN SODIUM 20 MG PO TABS [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0169-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS [21288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-333-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS [21290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13668-092-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"}]},{"description":"PRALIDOXIME CHLORIDE 1 G IV SOLR [6462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60977-141-27","type":"NDC"}],"standard_charges":[{"gross_charge":563.26,"discounted_cash":563.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"PRALATREXATE 40 MG/2ML IV SOLN [108073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9307","type":"HCPCS"},{"code":"48818-001-02","type":"NDC"}],"standard_charges":[{"gross_charge":33774.25,"discounted_cash":33774.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PRALATREXATE 20 MG/ML IV SOLN [99982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9307","type":"HCPCS"},{"code":"48818-001-01","type":"NDC"}],"standard_charges":[{"gross_charge":16875.13,"discounted_cash":16875.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"POWDERED MILK [4081137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-0004-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2000 G"}]},{"description":"POVIDONE-IODINE 5 % OP SOLN [19791]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0411-30","type":"NDC"}],"standard_charges":[{"gross_charge":65.52,"discounted_cash":65.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"POVIDONE-IODINE 10 % EX SOLN [6458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67618-150-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.8 ML"}]},{"description":"POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN [142241]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-7295-01","type":"NDC"}],"standard_charges":[{"gross_charge":107.62,"discounted_cash":107.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE ER 0.375 MG PO TB24 [101023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-208-07","type":"NDC"}],"standard_charges":[{"gross_charge":58.15,"discounted_cash":58.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.375 MG"},{"gross_charge":116.3,"discounted_cash":116.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"}]},{"description":"PRAVASTATIN SODIUM 20 MG PO TABS [11111]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7201-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PRASUGREL HCL 10 MG PO TABS [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-605-30","type":"NDC"}],"standard_charges":[{"gross_charge":96.48,"discounted_cash":96.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"PRASUGREL HCL 10 MG PO TABS [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-830-30","type":"NDC"}],"standard_charges":[{"gross_charge":147.99,"discounted_cash":147.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"PRASUGREL HCL 10 MG PO TABS [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4643-3","type":"NDC"}],"standard_charges":[{"gross_charge":38.7,"discounted_cash":38.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"PRASUGREL HCL 10 MG PO TABS [98373]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-273-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.64,"discounted_cash":35.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 EACH"}]},{"description":"PRAMOXINE-HC 1-1 % EX FOAM [11105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0037-6824-10","type":"NDC"}],"standard_charges":[{"gross_charge":591.96,"discounted_cash":591.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"PRAMLINTIDE ACETATE 2700 MCG/2.7ML SC SOPN [117461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0310-6627-02","type":"NDC"}],"standard_charges":[{"gross_charge":3661.87,"discounted_cash":3661.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.7 ML"}]},{"description":"PRAMIPEXOLE DIHYDROCHLORIDE ER 0.375 MG PO TB24 [101023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50742-331-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.375 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MG"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0409-6651-06","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN [6429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"0264-1944-20","type":"NDC"}],"standard_charges":[{"gross_charge":169.0,"discounted_cash":169.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"PIOGLITAZONE HCL 15 MG PO TABS [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5420-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE HCL 15 MG PO TABS [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7271-56","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PINDOLOL 5 MG PO TABS [6297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62559-560-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PIMOZIDE 2 MG PO TABS [11031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-348-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":42.88,"discounted_cash":42.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"},{"gross_charge":55.13,"discounted_cash":55.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PIOGLITAZONE HCL 15 MG PO TABS [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5420-92","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE HCL 30 MG PO TABS [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-513-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE HCL 30 MG PO TABS [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-055-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE HCL 30 MG PO TABS [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5421-92","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE HCL 30 MG PO TABS [25529]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5421-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PIOGLITAZONE HCL 15 MG PO TABS [25528]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-054-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-405-11","type":"NDC"}],"standard_charges":[{"gross_charge":50.19,"discounted_cash":50.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":125.48,"discounted_cash":125.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PHYTONADIONE 1 MG/0.5ML IJ SOLN [118229]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76329-1240-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":81.56,"discounted_cash":81.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":163.12,"discounted_cash":163.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"PHYSOSTIGMINE SALICYLATE 2 MG/5ML IJ SOLN [155623]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60733-4100-00","type":"NDC"}],"standard_charges":[{"gross_charge":206.88,"discounted_cash":206.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":413.75,"discounted_cash":413.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":827.5,"discounted_cash":827.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1241.25,"discounted_cash":1241.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":1655.0,"discounted_cash":1655.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"PHYSIOSOL IRRIGATION IR SOLN [6269]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0264-2205-00","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS [11019]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0071-3740-66","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":85.75,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"PIOGLITAZONE HCL 45 MG PO TABS [25530]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5422-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 MG"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598-405-11","type":"NDC"}],"standard_charges":[{"gross_charge":250.95,"discounted_cash":250.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN [11023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43598-405-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":71.04,"discounted_cash":71.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PIMECROLIMUS 1 % EX CREA [32052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68682-110-01","type":"NDC"}],"standard_charges":[{"gross_charge":619.2,"discounted_cash":619.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"PIMECROLIMUS 1 % EX CREA [32052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0187-5100-01","type":"NDC"}],"standard_charges":[{"gross_charge":1803.78,"discounted_cash":1803.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"PIMAVANSERIN TARTRATE 34 MG PO CAPS [137595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63090-340-30","type":"NDC"}],"standard_charges":[{"gross_charge":635.95,"discounted_cash":635.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 MG"}]},{"description":"PILOCARPINE HCL 5 MG PO TABS [12803]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0792-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"PILOCARPINE HCL 4 % OP SOLN [6282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":239.67,"discounted_cash":239.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE HCL 4 % OP SOLN [6282]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1747-8","type":"NDC"}],"standard_charges":[{"gross_charge":304.2,"discounted_cash":304.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE HCL 2 % OP SOLN [6280]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-204-15","type":"NDC"}],"standard_charges":[{"gross_charge":449.64,"discounted_cash":449.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN [6279]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-181-01","type":"NDC"}],"standard_charges":[{"gross_charge":226.44,"discounted_cash":226.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PIFLUFOLASTAT F 18 9 MCI IV SOSY [146118]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"#NAME?","type":"RC"},{"code":"A9595","type":"HCPCS"},{"code":"71258-022-00","type":"NDC"}],"standard_charges":[{"gross_charge":6409.19,"discounted_cash":6409.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MILLICURIE"}]},{"description":"PHYTONADIONE 5 MG PO TABS [11024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1014-1","type":"NDC"}],"standard_charges":[{"gross_charge":145.13,"discounted_cash":145.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.29,"discounted_cash":36.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 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[18304]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3383-11","type":"NDC"}],"standard_charges":[{"gross_charge":61.53,"discounted_cash":61.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68001-507-82","type":"NDC"}],"standard_charges":[{"gross_charge":53.47,"discounted_cash":53.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PLASMA-LYTE A IV SOLN [6331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0338-0221-03","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR [18303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-121-41","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":45.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6159-0","type":"NDC"}],"standard_charges":[{"gross_charge":43.69,"discounted_cash":43.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIROXICAM 20 MG PO CAPS [6311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-177-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"}]},{"description":"PIPERACILLIN-TAZOBACTAM IN DEX 4-0.5 GM/100ML IV SOLN [108121]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0206-8862-01","type":"NDC"}],"standard_charges":[{"gross_charge":103.97,"discounted_cash":103.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM IN DEX 3-0.375 GM/50ML IV SOLN [34524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0206-8861-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.24,"discounted_cash":88.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.375 G"}]},{"description":"PIPERACILLIN-TAZOBACTAM IN DEX 2-0.25 GM/50ML IV SOLN [34523]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0206-8860-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.48,"discounted_cash":73.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 G"},{"gross_charge":146.95,"discounted_cash":146.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72485-404-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.93,"discounted_cash":45.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-259-15","type":"NDC"}],"standard_charges":[{"gross_charge":47.66,"discounted_cash":47.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"64679-012-02","type":"NDC"}],"standard_charges":[{"gross_charge":51.9,"discounted_cash":51.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"64679-012-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.85,"discounted_cash":62.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-982-43","type":"NDC"}],"standard_charges":[{"gross_charge":55.24,"discounted_cash":55.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6159-4","type":"NDC"}],"standard_charges":[{"gross_charge":43.49,"discounted_cash":43.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR [18302]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-3390-11","type":"NDC"}],"standard_charges":[{"gross_charge":98.83,"discounted_cash":98.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 G"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0955-01","type":"NDC"}],"standard_charges":[{"gross_charge":245.47,"discounted_cash":245.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN [6030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-142-10","type":"NDC"}],"standard_charges":[{"gross_charge":121.1,"discounted_cash":121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN [6030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"14789-121-05","type":"NDC"}],"standard_charges":[{"gross_charge":111.09,"discounted_cash":111.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG PO TABS [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-187-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG PO TABS [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-075-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG PO TABS [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-621-15","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG PO TABS [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-621-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG PO TABS [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-220-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0641-6078-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0641-6078-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0409-4755-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6130-5","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6130-0","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-548-42","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG PO TABS [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0440-7882-02","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG PO TBDP [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-078-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG PO TBDP [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-078-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG PO TBDP [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-157-13","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG PO TBDP [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-246-04","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG PO TBDP [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-390-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG PO TBDP [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-391-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG PO TABS [10778]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0675-15","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG PO TBDP [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-158-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 8 MG PO TBDP [27698]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-247-17","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-547-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"OXACILLIN SODIUM 2 G/20ML IJ (WET SOLR VIAL) [150466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-812-20","type":"NDC"}],"standard_charges":[{"gross_charge":57.58,"discounted_cash":57.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OXACILLIN SODIUM 1 G/10ML IJ (WET SOLR VIAL) [150463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-813-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OXACILLIN SODIUM 1 G IJ SOLR [5924]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-813-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OSIMERTINIB MESYLATE 80 MG PO TABS [129728]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-1350-30","type":"NDC"}],"standard_charges":[{"gross_charge":852.64,"discounted_cash":852.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":1705.27,"discounted_cash":1705.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OSIMERTINIB MESYLATE 40 MG PO TABS [129727]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-1349-30","type":"NDC"}],"standard_charges":[{"gross_charge":2923.32,"discounted_cash":2923.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":5846.64,"discounted_cash":5846.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-044-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR PHOSPHATE 75 MG PO CAPS [26546]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-415-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47781-384-26","type":"NDC"}],"standard_charges":[{"gross_charge":29.89,"discounted_cash":29.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":74.72,"discounted_cash":74.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021-233-20","type":"NDC"}],"standard_charges":[{"gross_charge":44.36,"discounted_cash":44.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR [110998]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-139-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"50742-406-20","type":"NDC"}],"standard_charges":[{"gross_charge":139.28,"discounted_cash":139.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"61703-363-22","type":"NDC"}],"standard_charges":[{"gross_charge":111.74,"discounted_cash":111.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXAZEPAM 10 MG PO CAPS [5930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-812-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 10 MG PO CAPS [5930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-290-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAPROZIN 600 MG PO TABS [10825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69238-1120-1","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"72266-161-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.9,"discounted_cash":137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457-469-10","type":"NDC"}],"standard_charges":[{"gross_charge":43.18,"discounted_cash":43.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505-6132-6","type":"NDC"}],"standard_charges":[{"gross_charge":78.74,"discounted_cash":78.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN [99610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"0955-1731-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.17,"discounted_cash":44.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"72266-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":231.8,"discounted_cash":231.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288-101-20","type":"NDC"}],"standard_charges":[{"gross_charge":110.6,"discounted_cash":110.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"68001-468-37","type":"NDC"}],"standard_charges":[{"gross_charge":179.24,"discounted_cash":179.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN [99612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505-6132-7","type":"NDC"}],"standard_charges":[{"gross_charge":110.36,"discounted_cash":110.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ONDANSETRON 4 MG PO TBDP [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63629-4014-4","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-042-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN [106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-6130-0","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55150-125-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"25021-777-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-548-31","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-547-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63323-373-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN FOR PO USE [4082106348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67457-440-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-675-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [88704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-797-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ORPHENADRINE CITRATE ER 100 MG PO TB12 [38213]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43386-480-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN [5886]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6182-25","type":"NDC"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN [5886]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6182-01","type":"NDC"}],"standard_charges":[{"gross_charge":114.54,"discounted_cash":114.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ORLISTAT 60 MG PO CAPS [81473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0135-0461-05","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ORA-SWEET SF PO SYRP [5853]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0395-0094-16","type":"NDC"}],"standard_charges":[{"gross_charge":62.44,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ORA-PLUS PO LIQD [5851]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0303-16","type":"NDC"}],"standard_charges":[{"gross_charge":96.5,"discounted_cash":96.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN [18877]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60687-252-40","type":"NDC"}],"standard_charges":[{"gross_charge":61.44,"discounted_cash":61.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":122.88,"discounted_cash":122.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"OXAZEPAM 10 MG PO CAPS [5930]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-812-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"ONDANSETRON 4 MG PO TBDP [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63187-256-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"OLANZAPINE 5 MG PO TABS [17936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-381-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.88,"discounted_cash":42.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 5 MG PO TABS [17936]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-068-07","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.88,"discounted_cash":42.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 2.5 MG PO TABS [21057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-163-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":85.75,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-615-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-320-55","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-320-52","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-5510-93","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 10 MG PO TABS [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-070-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":21.44,"discounted_cash":21.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2359","type":"HCPCS"},{"code":"55150-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":110.2,"discounted_cash":110.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":55.1,"discounted_cash":55.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-308-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2359","type":"HCPCS"},{"code":"0781-9105-72","type":"NDC"}],"standard_charges":[{"gross_charge":114.76,"discounted_cash":114.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":57.38,"discounted_cash":57.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-9105-72","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2359","type":"HCPCS"},{"code":"0781-3159-72","type":"NDC"}],"standard_charges":[{"gross_charge":114.76,"discounted_cash":114.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":114.76,"discounted_cash":114.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 10 MG IM SOLR [38263]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3159-72","type":"NDC"}],"standard_charges":[{"gross_charge":114.76,"discounted_cash":114.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"OLANZAPINE 10 MG PO TABS [17937]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43598-166-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":21.44,"discounted_cash":21.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 2.5 MG PO TABS [21057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-067-07","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":85.75,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-262-79","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42291-657-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70512-520-05","type":"NDC"}],"standard_charges":[{"gross_charge":42.45,"discounted_cash":42.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-017-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.79,"discounted_cash":20.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70069-007-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.37,"discounted_cash":92.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69367-233-05","type":"NDC"}],"standard_charges":[{"gross_charge":36.48,"discounted_cash":36.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51293-838-85","type":"NDC"}],"standard_charges":[{"gross_charge":33.9,"discounted_cash":33.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN [19452]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"46122-672-64","type":"NDC"}],"standard_charges":[{"gross_charge":27.21,"discounted_cash":27.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OLODATEROL HCL 2.5 MCG/ACT IN AERS [126243]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0597-0192-61","type":"NDC"}],"standard_charges":[{"gross_charge":103.71,"discounted_cash":103.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"}]},{"description":"OLMESARTAN MEDOXOMIL 5 MG PO TABS [32761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-436-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLMESARTAN MEDOXOMIL 5 MG PO TABS [32761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-741-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-552-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS [41822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-761-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"ONDANSETRON 4 MG PO TBDP [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-077-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONDANSETRON 4 MG PO TBDP [27697]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-7732-93","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ONABOTULINUMTOXINA 200 UNITS IJ SOLR [100509]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0023-3921-02","type":"NDC"}],"standard_charges":[{"gross_charge":48.64,"discounted_cash":48.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"},{"gross_charge":97.28,"discounted_cash":97.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 UNITS"},{"gross_charge":145.91,"discounted_cash":145.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 UNITS"}]},{"description":"ONABOTULINUMTOXINA 100 UNITS IJ SOLR [100610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0585","type":"HCPCS"},{"code":"0023-1145-02","type":"NDC"}],"standard_charges":[{"gross_charge":3883.42,"discounted_cash":3883.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ONABOTULINUMTOXINA 100 UNITS IJ SOLR [100610]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0585","type":"HCPCS"},{"code":"0023-1145-01","type":"NDC"}],"standard_charges":[{"gross_charge":4172.32,"discounted_cash":4172.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"OMEPRAZOLE 40 MG PO CPDR [27695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62175-136-32","type":"NDC"}],"standard_charges":[{"gross_charge":37.38,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":37.38,"discounted_cash":37.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"OLMESARTAN MEDOXOMIL 5 MG PO TABS [32761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65597-101-30","type":"NDC"}],"standard_charges":[{"gross_charge":72.5,"discounted_cash":72.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":144.99,"discounted_cash":144.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":289.97,"discounted_cash":289.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":36.25,"discounted_cash":36.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-306-32","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59746-306-12","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-262-81","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE 5 MG PO TBDP [28159]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3275-3","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLMESARTAN MEDOXOMIL 5 MG PO TABS [32761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-131-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLMESARTAN MEDOXOMIL 20 MG PO TABS [32762]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-437-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLMESARTAN MEDOXOMIL 20 MG PO TABS [32762]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-321-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OLANZAPINE-FLUOXETINE HCL 6-25 MG PO CAPS [37665]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0002-3231-30","type":"NDC"}],"standard_charges":[{"gross_charge":80.16,"discounted_cash":80.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN [6030]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"14789-121-07","type":"NDC"}],"standard_charges":[{"gross_charge":150.19,"discounted_cash":150.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OXAZEPAM 15 MG PO CAPS [5931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2069-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN ONE-STEP [4084080064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71266-5000-1","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN ONE-STEP [4084080064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1552-07","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN ONE-STEP [4084080064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092-1068-07","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN ONE-STEP [4084080064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69374-543-50","type":"NDC"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ SOLN [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-012-11","type":"NDC"}],"standard_charges":[{"gross_charge":45.34,"discounted_cash":45.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":45.34,"discounted_cash":45.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN ONE-STEP [4084080064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71266-5102-1","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ SOLN [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-012-06","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ SOLN [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023-116-83","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN ONE-STEP [4084080064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"9999-9003-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"PALIPERIDONE ER 3 MG PO TB24 [78064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-765-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC [31097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"68001-516-27","type":"NDC"}],"standard_charges":[{"gross_charge":254.3,"discounted_cash":254.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC [31097]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"0703-3218-01","type":"NDC"}],"standard_charges":[{"gross_charge":85.7,"discounted_cash":85.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PACLITAXEL 30 MG/5ML IV CONC [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703-342-09","type":"NDC"}],"standard_charges":[{"gross_charge":97.74,"discounted_cash":97.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PACLITAXEL 30 MG/5ML IV CONC [31025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"0703-3213-81","type":"NDC"}],"standard_charges":[{"gross_charge":86.93,"discounted_cash":86.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PACLITAXEL 100 MG/16.7ML IV CONC [31096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"0703-3216-81","type":"NDC"}],"standard_charges":[{"gross_charge":115.39,"discounted_cash":115.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.7 ML"}]},{"description":"PACLITAXEL 100 MG/16.7ML IV CONC [31096]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"0703-3216-01","type":"NDC"}],"standard_charges":[{"gross_charge":115.35,"discounted_cash":115.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.7 ML"}]},{"description":"OYSTER SHELL CALCIUM 500 MG PO TABS [5955]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"20555-00300","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"OYSTER SHELL CALCIUM 500 MG PO TABS [5955]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-1883-72","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"OXYTOCIN 10 UNIT/ML IJ SOLN [5944]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023-116-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UNITS"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 UNITS"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0522-62","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5-325 MG PO TABS [31863]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0522-23","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-355-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-355-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-642-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-642-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6761-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7427-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYQUINOLINE-SOD LAURYL SULF 0.025-0.01 % VA GEL [137565]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59365-5030-0","type":"NDC"}],"standard_charges":[{"gross_charge":160.58,"discounted_cash":160.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113.4 G"}]},{"description":"OXYMORPHONE HCL ER 10 MG PO TB12 [76678]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64896-697-13","type":"NDC"}],"standard_charges":[{"gross_charge":59.88,"discounted_cash":59.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":119.76,"discounted_cash":119.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":239.52,"discounted_cash":239.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":29.94,"discounted_cash":29.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYMORPHONE HCL 5 MG PO TABS [76675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63824-125-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-165-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41100-81127","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41100-81123","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-352-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"11523-4112-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN [5943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7006-35","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PALIPERIDONE ER 3 MG PO TB24 [78064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-281-03","type":"NDC"}],"standard_charges":[{"gross_charge":25.81,"discounted_cash":25.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":51.62,"discounted_cash":51.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":77.42,"discounted_cash":77.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 6000-19000 UNITS PO CPEP [98034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0032-0046-70","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18000 UNITS"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24000 UNITS"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36000 UNITS"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 24000-76000 UNITS PO CPEP [98036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0032-2636-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.15,"discounted_cash":25.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS"},{"gross_charge":37.72,"discounted_cash":37.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18000 UNITS"},{"gross_charge":50.29,"discounted_cash":50.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24000 UNITS"},{"gross_charge":75.43,"discounted_cash":75.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36000 UNITS"},{"gross_charge":12.58,"discounted_cash":12.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 24000-76000 UNITS PO CPEP [98036]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0032-1224-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.68,"discounted_cash":25.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS"},{"gross_charge":38.52,"discounted_cash":38.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18000 UNITS"},{"gross_charge":51.36,"discounted_cash":51.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24000 UNITS"},{"gross_charge":77.04,"discounted_cash":77.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36000 UNITS"},{"gross_charge":12.84,"discounted_cash":12.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 6000-19000 UNITS PO CPEP [98034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0032-1206-07","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18000 UNITS"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24000 UNITS"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36000 UNITS"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 12000-38000 UNITS PO CPEP [98035]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0032-1212-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.94,"discounted_cash":25.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS"},{"gross_charge":38.9,"discounted_cash":38.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18000 UNITS"},{"gross_charge":51.87,"discounted_cash":51.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24000 UNITS"},{"gross_charge":77.8,"discounted_cash":77.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36000 UNITS"},{"gross_charge":12.97,"discounted_cash":12.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-560-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG PO TBEC [26225]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-560-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67850-150-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67850-150-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-202-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-202-00","type":"NDC"}],"standard_charges":[{"gross_charge":52.93,"discounted_cash":52.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3232-94","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9284-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.21,"discounted_cash":64.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR [26226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0008-0923-51","type":"NDC"}],"standard_charges":[{"gross_charge":43.68,"discounted_cash":43.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"PANTOPRAZOLE 80 MG IN 0.9% SODIUM CHLORIDE 250 ML [408400203]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-0202-99","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"PANITUMUMAB 400 MG/20ML IV SOLN [108057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513-956-01","type":"NDC"}],"standard_charges":[{"gross_charge":17414.22,"discounted_cash":17414.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"PANITUMUMAB 100 MG/5ML IV SOLN [108055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513-954-01","type":"NDC"}],"standard_charges":[{"gross_charge":4386.56,"discounted_cash":4386.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PALIPERIDONE PALMITATE ER 234 MG/1.5ML IM SUSY [139428]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458-564-01","type":"NDC"}],"standard_charges":[{"gross_charge":6365.6,"discounted_cash":6365.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 117 MG"},{"gross_charge":8487.46,"discounted_cash":8487.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 156 MG"},{"gross_charge":12731.19,"discounted_cash":12731.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 234 MG"},{"gross_charge":2121.87,"discounted_cash":2121.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 MG"},{"gross_charge":4243.73,"discounted_cash":4243.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 MG"}]},{"description":"PALIPERIDONE PALMITATE ER 156 MG/ML IM SUSY [139427]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458-563-01","type":"NDC"}],"standard_charges":[{"gross_charge":6372.01,"discounted_cash":6372.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 117 MG"},{"gross_charge":8496.01,"discounted_cash":8496.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 156 MG"},{"gross_charge":12744.01,"discounted_cash":12744.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 234 MG"},{"gross_charge":2124.01,"discounted_cash":2124.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 MG"},{"gross_charge":4248.01,"discounted_cash":4248.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 MG"}]},{"description":"PALIPERIDONE PALMITATE ER 117 MG/0.75ML IM SUSY [139426]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458-562-01","type":"NDC"}],"standard_charges":[{"gross_charge":6378.02,"discounted_cash":6378.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 117 MG"},{"gross_charge":12756.04,"discounted_cash":12756.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 156 MG"},{"gross_charge":12756.04,"discounted_cash":12756.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 234 MG"},{"gross_charge":6378.02,"discounted_cash":6378.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 MG"},{"gross_charge":6378.02,"discounted_cash":6378.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 MG"}]},{"description":"PALIPERIDONE ER 6 MG PO TB24 [78065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3980-93","type":"NDC"}],"standard_charges":[{"gross_charge":67.22,"discounted_cash":67.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":67.22,"discounted_cash":67.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":134.44,"discounted_cash":134.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"PANCRELIPASE (LIP-PROT-AMYL) 12000-38000 UNITS PO CPEP [98035]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0032-0047-70","type":"NDC"}],"standard_charges":[{"gross_charge":25.38,"discounted_cash":25.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12000 UNITS"},{"gross_charge":38.07,"discounted_cash":38.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18000 UNITS"},{"gross_charge":50.75,"discounted_cash":50.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24000 UNITS"},{"gross_charge":76.13,"discounted_cash":76.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 36000 UNITS"},{"gross_charge":12.69,"discounted_cash":12.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6000 UNITS"}]},{"description":"PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN [32855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-326-18","type":"NDC"}],"standard_charges":[{"gross_charge":184.84,"discounted_cash":184.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PAMIDRONATE DISODIUM 6 MG/ML IV SOLN [33886]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-325-18","type":"NDC"}],"standard_charges":[{"gross_charge":166.54,"discounted_cash":166.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN [32589]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-324-18","type":"NDC"}],"standard_charges":[{"gross_charge":91.6,"discounted_cash":91.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOSY [138025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"25021-788-74","type":"NDC"}],"standard_charges":[{"gross_charge":55.57,"discounted_cash":55.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"}]},{"description":"PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY [139425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2426","type":"HCPCS"},{"code":"50458-561-01","type":"NDC"}],"standard_charges":[{"gross_charge":6245.35,"discounted_cash":6245.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 117 MG"},{"gross_charge":8327.13,"discounted_cash":8327.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 156 MG"},{"gross_charge":12490.69,"discounted_cash":12490.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 234 MG"},{"gross_charge":2081.79,"discounted_cash":2081.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 39 MG"},{"gross_charge":4163.57,"discounted_cash":4163.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 MG"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-203-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE HCL 5 MG PO TABS [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0552-23","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 15 MG PO TABS [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-975-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 15 MG PO TABS [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-975-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 15 MG PO TABS [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7180-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 15 MG PO TABS [28899]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-8515-23","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE ER 5 MG PO TB24 [24470]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 5 MG PO TABS [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0552-62","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-406-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-406-67","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-406-40","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6828-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-4827-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG PO TABS [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-354-01","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 5 MG PO TABS [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"10702-018-50","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYCODONE HCL 5 MG PO TABS [10814]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6966-61","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG PO TABS [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-456-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXCARBAZEPINE 150 MG PO TABS [27049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68084-845-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 150 MG PO TABS [27049]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-7262-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXAZEPAM 15 MG PO CAPS [5931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-813-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 15 MG PO CAPS [5931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62584-813-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXAZEPAM 15 MG PO CAPS [5931]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52817-291-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN [10813]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64950-354-05","type":"NDC"}],"standard_charges":[{"gross_charge":32.73,"discounted_cash":32.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-722-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG PO TABS [5938]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-810-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"OXYBUTYNIN 3.9 MG/24HR TD PTTW [35495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-6153-08","type":"NDC"}],"standard_charges":[{"gross_charge":502.49,"discounted_cash":502.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 PATCH"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68084-853-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68084-853-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXCARBAZEPINE 300 MG PO TABS [21061]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-722-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"OXYCODONE HCL ER 10 MG PO T12A [123607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-410-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":33.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":134.0,"discounted_cash":134.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":267.99,"discounted_cash":267.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0512-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68308-480-47","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-710-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-710-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-646-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0512-23","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7095-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0512-62","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-644-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-644-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42858-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS [5940]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7093-61","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0523-23","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE HCL ER 20 MG PO T12A [123609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-420-20","type":"NDC"}],"standard_charges":[{"gross_charge":64.08,"discounted_cash":64.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":512.64,"discounted_cash":512.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":64.08,"discounted_cash":64.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":128.16,"discounted_cash":128.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":256.32,"discounted_cash":256.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE HCL ER 20 MG PO T12A [123609]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-420-10","type":"NDC"}],"standard_charges":[{"gross_charge":62.48,"discounted_cash":62.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":499.78,"discounted_cash":499.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":62.48,"discounted_cash":62.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":124.95,"discounted_cash":124.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":249.89,"discounted_cash":249.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE HCL ER 15 MG PO T12A [123608]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-415-20","type":"NDC"}],"standard_charges":[{"gross_charge":50.6,"discounted_cash":50.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":101.2,"discounted_cash":101.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"OXYCODONE HCL ER 10 MG PO T12A [123607]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-410-20","type":"NDC"}],"standard_charges":[{"gross_charge":34.4,"discounted_cash":34.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":68.79,"discounted_cash":68.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":68.79,"discounted_cash":68.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":137.57,"discounted_cash":137.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":275.14,"discounted_cash":275.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS [31864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0523-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"OXYCODONE HCL ER 80 MG PO T12A [123613]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-480-20","type":"NDC"}],"standard_charges":[{"gross_charge":191.5,"discounted_cash":191.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":383.0,"discounted_cash":383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":191.5,"discounted_cash":191.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":191.5,"discounted_cash":191.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":191.5,"discounted_cash":191.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"OXYCODONE HCL ER 40 MG PO T12A [123611]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59011-440-20","type":"NDC"}],"standard_charges":[{"gross_charge":109.7,"discounted_cash":109.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":438.8,"discounted_cash":438.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":109.7,"discounted_cash":109.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":109.7,"discounted_cash":109.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":219.4,"discounted_cash":219.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR [133866]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"58160-819-12","type":"NDC"}],"standard_charges":[{"gross_charge":1437.98,"discounted_cash":1437.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MCG"}]},{"description":"CEVIMELINE HCL 30 MG PO CAPS [27253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"16571-657-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS [9081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"13107-070-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS [9081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-341-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 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[466]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2145-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN SODIUM 0.002 MG/ML SOLUTION (STOCK F) [40890021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-12","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMPICILLIN SODIUM 0.02 MG/ML SOLUTION (STOCK E) [40890023]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-13","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMPICILLIN SODIUM 0.2 MG/ML SOLUTION (STOCK D) [40890025]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-14","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR [469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3404-95","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"AMPICILLIN SODIUM 1 G IJ SOLR [469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-113-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"AMPICILLIN SODIUM 100 MG/ML SOLUTION (STOCK A) [40890031]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-17","type":"NDC"}],"standard_charges":[{"gross_charge":2180.8,"discounted_cash":2180.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-137-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.58,"discounted_cash":45.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67850-022-00","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":47.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67850-022-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72485-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR [472]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72485-422-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"AMPICILLIN SODIUM 0.0002 MG/ML SOLUTION (STOCK G) [40890019]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS [33228]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66685-1001-0","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN 250 MG PO CAPS [450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-2020-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG PO CAPS [450]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57237-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG/5ML PO SUSR [454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4155-79","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG/5ML PO SUSR [454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9889-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG/5ML PO SUSR [454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6041-55","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMOXICILLIN 250 MG/5ML PO SUSR [454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1067-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"AMOXICILLIN 500 MG PO CAPS [451]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-017-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 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[33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-502-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS [33227]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1831-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-534-75","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR [33230]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-534-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5ML PO SUSR [9080]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"81964-204-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.31,"discounted_cash":14.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":28.62,"discounted_cash":28.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AMPICILLIN SODIUM 2 MG/ML SOLUTION (STOCK C) [40890027]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-15","type":"NDC"}],"standard_charges":[{"gross_charge":68.2,"discounted_cash":68.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5ML PO SUSR 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[22992]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-501-30","type":"NDC"}],"standard_charges":[{"gross_charge":25.23,"discounted_cash":25.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"AMPICILLIN SODIUM 20 MG/ML SOLUTION (STOCK B) [40890029]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-6003-16","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMPICILLIN SODIUM 250 MG IJ SOLR [473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-9242-95","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AMPICILLIN SODIUM 250 MG IJ SOLR [473]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-014-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ANASTROZOLE 1 MG PO TABS [16205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-112-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ANASTROZOLE 1 MG PO TABS [16205]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-112-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy 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[40899912]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43066-360-20","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMIODARONE HCL BOLUS FROM BAG [40899912]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066-360-20","type":"NDC"}],"standard_charges":[{"gross_charge":826.12,"discounted_cash":826.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":237.0,"discounted_cash":237.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN [110257]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"43066-150-10","type":"NDC"}],"standard_charges":[{"gross_charge":215.2,"discounted_cash":215.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"AMITRIPTYLINE HCL 10 MG PO TABS [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-171-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE HCL 10 MG PO TABS [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-171-17","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE HCL 10 MG PO TABS [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-419-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMINOCAPROIC ACID 500 MG PO TABS [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70377-102-11","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"ALVIMOPAN 12 MG PO CAPS [91870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2312-45","type":"NDC"}],"standard_charges":[{"gross_charge":829.08,"discounted_cash":829.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ALVIMOPAN 12 MG PO CAPS [91870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51407-870-33","type":"NDC"}],"standard_charges":[{"gross_charge":471.38,"discounted_cash":471.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"AMANTADINE HCL 100 MG PO CAPS [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7042-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 100 MG PO CAPS [364]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-422-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN [146527]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0646-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.08,"discounted_cash":22.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"AMIKACIN SULFATE 1 GM/4ML IJ SOLN [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155-786-31","type":"NDC"}],"standard_charges":[{"gross_charge":72.84,"discounted_cash":72.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMIKACIN SULFATE 1 GM/4ML IJ SOLN [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"23155-786-41","type":"NDC"}],"standard_charges":[{"gross_charge":72.84,"discounted_cash":72.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMIKACIN SULFATE 1 GM/4ML IJ SOLN [108133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0278","type":"HCPCS"},{"code":"25021-173-04","type":"NDC"}],"standard_charges":[{"gross_charge":78.57,"discounted_cash":78.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"AMILORIDE HCL 5 MG PO TABS [391]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0292-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMILORIDE-HYDROCHLOROTHIAZIDE 5-50 MG PO TABS [392]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0555-0483-02","type":"NDC"}],"standard_charges":[{"gross_charge":1225.0,"discounted_cash":1225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 TABLET"}]},{"description":"AMINOCAPROIC ACID 0.25 GM/ML PO SOLN [128888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-035-23","type":"NDC"}],"standard_charges":[{"gross_charge":40.77,"discounted_cash":40.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 G"},{"gross_charge":130.47,"discounted_cash":130.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"},{"gross_charge":163.08,"discounted_cash":163.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 0.25 GM/ML PO SOLN [128888]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-330-08","type":"NDC"}],"standard_charges":[{"gross_charge":88.44,"discounted_cash":88.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 G"},{"gross_charge":283.01,"discounted_cash":283.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 G"},{"gross_charge":353.76,"discounted_cash":353.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 500 MG PO TABS [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69680-115-30","type":"NDC"}],"standard_charges":[{"gross_charge":71.31,"discounted_cash":71.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":142.61,"discounted_cash":142.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":213.92,"discounted_cash":213.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":356.52,"discounted_cash":356.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 500 MG PO TABS [9063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-768-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 G"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML IV SOLN [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9120-25","type":"NDC"}],"standard_charges":[{"gross_charge":79.96,"discounted_cash":79.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML IV SOLN [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-9120-01","type":"NDC"}],"standard_charges":[{"gross_charge":66.88,"discounted_cash":66.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML IV SOLN [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4346-73","type":"NDC"}],"standard_charges":[{"gross_charge":51.4,"discounted_cash":51.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML IV SOLN [403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4346-16","type":"NDC"}],"standard_charges":[{"gross_charge":62.32,"discounted_cash":62.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"AMITRIPTYLINE HCL 10 MG PO TABS [432]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-201-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-199-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-199-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-199-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-721-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-123-16","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6369-61","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMOXICILLIN 125 MG/5ML PO SUSR [453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-706-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"AMOXICILLIN 125 MG/5ML PO SUSR [453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0143-9888-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN [10380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71399-0140-8","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 225 G"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN [10380]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-5984-26","type":"NDC"}],"standard_charges":[{"gross_charge":45.9,"discounted_cash":45.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 226 G"}]},{"description":"AMLODIPINE BESYLATE 5 MG PO TABS [9071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-198-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-197-90","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 2.5 MG PO TABS [9070]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-197-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMLODIPINE BESYLATE 10 MG PO TABS [9069]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-2135-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMITRIPTYLINE HCL 25 MG PO TABS [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1487-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE HCL 25 MG PO TABS [435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-202-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE HCL 50 MG PO TABS [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1488-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMLODIPINE BESYLATE 1 MG/ML PO SUSP [40840051]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-5001-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"AMIVANTAMAB-VMJW 350 MG/7ML IV SOLN [145872]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9061","type":"HCPCS"},{"code":"57894-501-01","type":"NDC"}],"standard_charges":[{"gross_charge":12790.08,"discounted_cash":12790.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"AMITRIPTYLINE HCL 50 MG PO TABS [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-421-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"AMITRIPTYLINE HCL 50 MG PO TABS [436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-173-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"ALVIMOPAN 12 MG PO CAPS [91870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2312-15","type":"NDC"}],"standard_charges":[{"gross_charge":682.72,"discounted_cash":682.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ATENOLOL 25 MG PO TABS [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0787-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 25 MG PO TABS [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0787-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 25 MG PO TABS [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0218-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATENOLOL 25 MG PO TABS [717]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-022-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATAZANAVIR SULFATE 200 MG PO CAPS [36150]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0003-3631-12","type":"NDC"}],"standard_charges":[{"gross_charge":147.33,"discounted_cash":147.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":147.33,"discounted_cash":147.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":294.66,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":294.66,"discounted_cash":294.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ATENOLOL 50 MG PO TABS [718]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-169-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ATOGEPANT 60 MG PO TABS [146994]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0074-7094-30","type":"NDC"}],"standard_charges":[{"gross_charge":39.8,"discounted_cash":39.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":119.38,"discounted_cash":119.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":238.76,"discounted_cash":238.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE HCL 10 MG PO CAPS [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-3227-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE HCL 10 MG PO CAPS [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3542-56","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ASPIRIN 81 MG PO CAPS [146190]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"73089-081-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ASPIRIN 81 MG PO CHEW [680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6794-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG PO CHEW [680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6794-89","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG PO CHEW [680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"12843-13105","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG PO CHEW [680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"48433-129-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 324 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG PO TBEC [688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-43196","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ATAZANAVIR SULFATE 150 MG PO CAPS [36149]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-444-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12 [27644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-405-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12 [27644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-596-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"ASPIRIN 81 MG PO TBEC [688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-43212","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASPIRIN 81 MG PO TBEC [688]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-43211","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ATOMOXETINE HCL 10 MG PO CAPS [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-714-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70377-027-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0071-0156-23","type":"NDC"}],"standard_charges":[{"gross_charge":20.05,"discounted_cash":20.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":20.05,"discounted_cash":20.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":40.1,"discounted_cash":40.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":80.19,"discounted_cash":80.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-3951-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-2579-8","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-2579-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 80 MG PO TABS [28645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0093-5057-98","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 40 MG PO TABS [19177]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"75834-257-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-2578-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 20 MG PO TABS [19178]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"68645-481-54","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ASPIRIN 600 MG RE SUPP [696]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7036-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ATOMOXETINE HCL 10 MG PO CAPS [34444]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-519-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE HCL 25 MG PO CAPS [34446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"55111-528-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":19.6,"discounted_cash":19.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":29.4,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE HCL 40 MG PO CAPS [34447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-3229-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATOMOXETINE HCL 40 MG PO CAPS [34447]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-268-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-5381-92","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-3950-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ATORVASTATIN CALCIUM 10 MG PO TABS [19176]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0071-0155-23","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ASPIRIN 325 MG PO TBEC [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-921-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ARIPIPRAZOLE 10 MG PO TABS [34369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-099-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 15 MG PO TABS [34370]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-100-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 2 MG PO TABS [70306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-302-03","type":"NDC"}],"standard_charges":[{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG PO TABS [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-098-30","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE 5 MG PO TABS [36438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-431-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ARIPIPRAZOLE ER 400 MG IM SRER [136424]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0401","type":"HCPCS"},{"code":"59148-019-71","type":"NDC"}],"standard_charges":[{"gross_charge":9748.63,"discounted_cash":9748.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 1064 MG/3.9ML IM PRSY [136098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1944","type":"HCPCS"},{"code":"65757-404-03","type":"NDC"}],"standard_charges":[{"gross_charge":13009.96,"discounted_cash":13009.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1064 MG"},{"gross_charge":5392.29,"discounted_cash":5392.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 441 MG"},{"gross_charge":8094.55,"discounted_cash":8094.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 662 MG"},{"gross_charge":10784.58,"discounted_cash":10784.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 882 MG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 441 MG/1.6ML IM PRSY [129504]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1944","type":"HCPCS"},{"code":"65757-401-03","type":"NDC"}],"standard_charges":[{"gross_charge":9967.9,"discounted_cash":9967.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1064 MG"},{"gross_charge":4131.44,"discounted_cash":4131.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 441 MG"},{"gross_charge":6201.84,"discounted_cash":6201.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 662 MG"},{"gross_charge":8262.87,"discounted_cash":8262.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 882 MG"}]},{"description":"ARGININE HCL (DIAGNOSTIC) 10 % IV SOLN [9123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0009-0436-01","type":"NDC"}],"standard_charges":[{"gross_charge":273.4,"discounted_cash":273.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"APRACLONIDINE HCL 0.5 % OP SOLN [9119]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"61314-665-05","type":"NDC"}],"standard_charges":[{"gross_charge":185.1,"discounted_cash":185.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"APREPITANT 130 MG/18ML IV EMUL [134073]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0185","type":"HCPCS"},{"code":"47426-201-01","type":"NDC"}],"standard_charges":[{"gross_charge":1597.05,"discounted_cash":1597.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 130 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-2321-06","type":"NDC"}],"standard_charges":[{"gross_charge":159.67,"discounted_cash":159.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"0781-2321-06","type":"NDC"}],"standard_charges":[{"gross_charge":498.96,"discounted_cash":498.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":319.34,"discounted_cash":319.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"13668-591-80","type":"NDC"}],"standard_charges":[{"gross_charge":429.31,"discounted_cash":429.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"13668-591-80","type":"NDC"}],"standard_charges":[{"gross_charge":1341.59,"discounted_cash":1341.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":858.62,"discounted_cash":858.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"13668-591-82","type":"NDC"}],"standard_charges":[{"gross_charge":520.02,"discounted_cash":520.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"13668-591-82","type":"NDC"}],"standard_charges":[{"gross_charge":1625.07,"discounted_cash":1625.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":1040.04,"discounted_cash":1040.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68462-583-40","type":"NDC"}],"standard_charges":[{"gross_charge":176.17,"discounted_cash":176.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"APREPITANT 40 MG PO CAPS [76843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J8501","type":"HCPCS"},{"code":"68462-583-40","type":"NDC"}],"standard_charges":[{"gross_charge":550.52,"discounted_cash":550.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":352.34,"discounted_cash":352.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"AQUAPHOR EX OINT [612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72140-03147","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 396 G"}]},{"description":"AQUAPHOR EX OINT [612]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72140-45231","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-770-79","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARGATROBAN 50 MG/50ML IV SOLN [111477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3314-95","type":"NDC"}],"standard_charges":[{"gross_charge":1365.79,"discounted_cash":1365.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARGATROBAN 250 MG/2.5ML IV SOLN [28947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-212-02","type":"NDC"}],"standard_charges":[{"gross_charge":3073.99,"discounted_cash":3073.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARGATROBAN 250 MG/2.5ML IV SOLN [28947]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"42023-182-89","type":"NDC"}],"standard_charges":[{"gross_charge":334.71,"discounted_cash":334.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-612-70","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70756-612-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70748-175-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70748-175-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.67,"discounted_cash":22.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-151-19","type":"NDC"}],"standard_charges":[{"gross_charge":20.74,"discounted_cash":20.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-911-64","type":"NDC"}],"standard_charges":[{"gross_charge":26.64,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-911-30","type":"NDC"}],"standard_charges":[{"gross_charge":28.12,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-911-04","type":"NDC"}],"standard_charges":[{"gross_charge":53.56,"discounted_cash":53.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"63402-911-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.82,"discounted_cash":64.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-770-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARFORMOTEROL TARTRATE 15 MCG/2ML IN NEBU [77581]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70436-151-57","type":"NDC"}],"standard_charges":[{"gross_charge":41.48,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MCG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 662 MG/2.4ML IM PRSY [129505]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1944","type":"HCPCS"},{"code":"65757-402-03","type":"NDC"}],"standard_charges":[{"gross_charge":4123.09,"discounted_cash":4123.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 441 MG"},{"gross_charge":6189.31,"discounted_cash":6189.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 662 MG"},{"gross_charge":8246.18,"discounted_cash":8246.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 882 MG"}]},{"description":"ASENAPINE MALEATE 10 MG SL SUBL [99755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2410-11","type":"NDC"}],"standard_charges":[{"gross_charge":120.85,"discounted_cash":120.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.43,"discounted_cash":60.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASENAPINE MALEATE 10 MG SL SUBL [99755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2410-60","type":"NDC"}],"standard_charges":[{"gross_charge":120.66,"discounted_cash":120.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":60.33,"discounted_cash":60.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASENAPINE MALEATE 10 MG SL SUBL [99755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-360-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASENAPINE MALEATE 10 MG SL SUBL [99755]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-2888-6","type":"NDC"}],"standard_charges":[{"gross_charge":20.53,"discounted_cash":20.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASENAPINE MALEATE 5 MG SL SUBL [99754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2405-11","type":"NDC"}],"standard_charges":[{"gross_charge":241.7,"discounted_cash":241.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":120.85,"discounted_cash":120.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASENAPINE MALEATE 5 MG SL SUBL [99754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0456-2405-60","type":"NDC"}],"standard_charges":[{"gross_charge":239.13,"discounted_cash":239.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":119.57,"discounted_cash":119.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASENAPINE MALEATE 5 MG SL SUBL [99754]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-358-60","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"ASPIRIN 1 MG/ML PO SOLN [408680]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999-794-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 ML"}]},{"description":"ASPIRIN 300 MG RE SUPP [693]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7034-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ASPIRIN 325 MG PO TBEC [685]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-921-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 162 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ASCORBIC ACID 500 MG/ML IJ SOLN [654]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67457-118-50","type":"NDC"}],"standard_charges":[{"gross_charge":571.6,"discounted_cash":571.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ASPIRIN 325 MG PO TABS [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-901-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASPIRIN 325 MG PO TABS [681]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-901-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ASCORBIC ACID 500 MG PO TABS [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"40985-22316","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 675 MG/2.4ML IM PRSY [137598]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1943","type":"HCPCS"},{"code":"65757-500-03","type":"NDC"}],"standard_charges":[{"gross_charge":7229.45,"discounted_cash":7229.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 675 MG"}]},{"description":"ARIPIPRAZOLE LAUROXIL ER 882 MG/3.2ML IM PRSY [129506]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1944","type":"HCPCS"},{"code":"65757-403-03","type":"NDC"}],"standard_charges":[{"gross_charge":5335.46,"discounted_cash":5335.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 441 MG"},{"gross_charge":8009.24,"discounted_cash":8009.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 662 MG"},{"gross_charge":10670.92,"discounted_cash":10670.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 882 MG"}]},{"description":"ARMODAFINIL 150 MG PO TABS [96966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3432-93","type":"NDC"}],"standard_charges":[{"gross_charge":94.11,"discounted_cash":94.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"ARMODAFINIL 150 MG PO TABS [96966]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-806-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"}]},{"description":"ARMODAFINIL 250 MG PO TABS [96967]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-807-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"ARMODAFINIL 50 MG PO TABS [96965]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-805-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN [29071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"50742-438-10","type":"NDC"}],"standard_charges":[{"gross_charge":826.88,"discounted_cash":826.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN [29071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"68382-997-01","type":"NDC"}],"standard_charges":[{"gross_charge":372.74,"discounted_cash":372.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN [29071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"68382-997-10","type":"NDC"}],"standard_charges":[{"gross_charge":310.1,"discounted_cash":310.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN [29071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"69918-720-01","type":"NDC"}],"standard_charges":[{"gross_charge":2249.15,"discounted_cash":2249.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN [29071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70121-1483-1","type":"NDC"}],"standard_charges":[{"gross_charge":298.99,"discounted_cash":298.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ARTEMETHER-LUMEFANTRINE 20-120 MG PO TABS [96948]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0568-45","type":"NDC"}],"standard_charges":[{"gross_charge":33.2,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":66.39,"discounted_cash":66.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"},{"gross_charge":99.58,"discounted_cash":99.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 TABLET"},{"gross_charge":132.77,"discounted_cash":132.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 TABLET"}]},{"description":"ASCORBIC ACID 500 MG PO TABS [664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-0523-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ASCORBIC ACID 25000 MG/50ML IV SOLN [136894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67157-101-50","type":"NDC"}],"standard_charges":[{"gross_charge":1625.2,"discounted_cash":1625.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ARTIFICIAL TEARS SOLN WR [40841412]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0536-1408-94","type":"NDC"}],"standard_charges":[{"gross_charge":26.64,"discounted_cash":26.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ARTIFICIAL TEARS OINT WR [40821064]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-6488-38","type":"NDC"}],"standard_charges":[{"gross_charge":6.97,"discounted_cash":6.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"ASCORBIC ACID 25000 MG/50ML IV SOLN [136894]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"67157-101-51","type":"NDC"}],"standard_charges":[{"gross_charge":1513.54,"discounted_cash":1513.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ALVIMOPAN 12 MG PO CAPS [91870]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0668-82","type":"NDC"}],"standard_charges":[{"gross_charge":623.71,"discounted_cash":623.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ALUMINUM CHLORIDE 20 % EX SOLN [9028]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0096-0707-37","type":"NDC"}],"standard_charges":[{"gross_charge":46.13,"discounted_cash":46.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 37.5 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-963-44","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72611-860-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72611-860-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACETYLCYSTEINE 600 MG PO CAPS [76335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"79854-04097","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACETYLCYSTEINE 600 MG PO CAPS [76335]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-7007-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACITRETIN 25 MG PO CAPS [13979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0115-1753-08","type":"NDC"}],"standard_charges":[{"gross_charge":18.3,"discounted_cash":18.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":45.74,"discounted_cash":45.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"ACITRETIN 25 MG PO CAPS [13979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42794-083-08","type":"NDC"}],"standard_charges":[{"gross_charge":24.87,"discounted_cash":24.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":62.17,"discounted_cash":62.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"}]},{"description":"ACLIDINIUM BROMIDE 400 MCG/ACT IN AEPB [117714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70515-002-02","type":"NDC"}],"standard_charges":[{"gross_charge":1596.47,"discounted_cash":1596.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACLIDINIUM BROMIDE 400 MCG/ACT IN AEPB [117714]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72124-002-02","type":"NDC"}],"standard_charges":[{"gross_charge":1353.6,"discounted_cash":1353.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACTIVATED CHARCOAL PO LIQD - CHERRY [40827098]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"66689-202-04","type":"NDC"}],"standard_charges":[{"gross_charge":15.72,"discounted_cash":15.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"ACYCLOVIR 200 MG PO CAPS [8969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5789-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR 200 MG PO CAPS [8969]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0042-6","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-259-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACYCLOVIR 200 MG/5ML PO SUSP [8970]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-681-47","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ACYCLOVIR 800 MG PO TABS [8972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-291-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"55150-154-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-03","type":"NDC"}],"standard_charges":[{"gross_charge":75.28,"discounted_cash":75.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-14","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN [23128]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323-325-43","type":"NDC"}],"standard_charges":[{"gross_charge":59.92,"discounted_cash":59.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ADALIMUMAB 40 MG/0.4ML SC AJKT [155024]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-0554-02","type":"NDC"}],"standard_charges":[{"gross_charge":14368.18,"discounted_cash":14368.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":3592.05,"discounted_cash":3592.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":7184.09,"discounted_cash":7184.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ADALIMUMAB 40 MG/0.8ML SC AJKT [155057]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-4339-07","type":"NDC"}],"standard_charges":[{"gross_charge":31721.55,"discounted_cash":31721.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":7930.39,"discounted_cash":7930.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":15860.78,"discounted_cash":15860.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN [38303]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-812-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-694-04","type":"NDC"}],"standard_charges":[{"gross_charge":25.01,"discounted_cash":25.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-690-30","type":"NDC"}],"standard_charges":[{"gross_charge":37.26,"discounted_cash":37.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN [14468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64950-374-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN [14468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1551-63","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG PO TABS [125348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0406-0484-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"ACETAZOLAMIDE 25 MG/ML PO SOLN [137711]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1050-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.98,"discounted_cash":106.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":213.96,"discounted_cash":213.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":427.92,"discounted_cash":427.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETAZOLAMIDE 250 MG PO TABS [113]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-288-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETAZOLAMIDE ER 500 MG PO CP12 [8962]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-243-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR [114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"23155-831-31","type":"NDC"}],"standard_charges":[{"gross_charge":45.47,"discounted_cash":45.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":90.94,"discounted_cash":90.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN [123]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-7604-25","type":"NDC"}],"standard_charges":[{"gross_charge":37.76,"discounted_cash":37.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ACETYLCYSTEINE 10 % IN SOLN [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-7510-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ACETYLCYSTEINE 10 % IN SOLN [122]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3307-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ACETIC ACID 5 % N/A SOLN [14702]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51552-055-06","type":"NDC"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ADALIMUMAB 40 MG/0.8ML SC PSKT [127801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0074-3799-02","type":"NDC"}],"standard_charges":[{"gross_charge":30451.63,"discounted_cash":30451.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":10150.55,"discounted_cash":10150.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":20301.09,"discounted_cash":20301.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ACETIC ACID 3 % N/A SOLN [15091]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"51552-051-06","type":"NDC"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ACETIC ACID 2 % OT SOLN [17801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"52817-816-15","type":"NDC"}],"standard_charges":[{"gross_charge":102.6,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETIC ACID 2 % OT SOLN [17801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50383-889-15","type":"NDC"}],"standard_charges":[{"gross_charge":62.46,"discounted_cash":62.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETIC ACID 0.25 % IR SOLN [8963]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0990-6143-22","type":"NDC"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR [114]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-853-50","type":"NDC"}],"standard_charges":[{"gross_charge":130.76,"discounted_cash":130.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":261.52,"discounted_cash":261.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"ACETIC ACID 2 % OT SOLN [17801]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60432-741-15","type":"NDC"}],"standard_charges":[{"gross_charge":256.86,"discounted_cash":256.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ADENOSINE 12 MCG/ML IN 500 ML BAG [40838703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-8387-03","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44206-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":303.81,"discounted_cash":303.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":607.62,"discounted_cash":607.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1215.24,"discounted_cash":1215.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5216-0","type":"NDC"}],"standard_charges":[{"gross_charge":231.8,"discounted_cash":231.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":463.6,"discounted_cash":463.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":927.2,"discounted_cash":927.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5216-1","type":"NDC"}],"standard_charges":[{"gross_charge":254.2,"discounted_cash":254.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":508.4,"discounted_cash":508.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1016.8,"discounted_cash":1016.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5216-2","type":"NDC"}],"standard_charges":[{"gross_charge":246.5,"discounted_cash":246.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":493.0,"discounted_cash":493.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":986.0,"discounted_cash":986.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5216-3","type":"NDC"}],"standard_charges":[{"gross_charge":335.8,"discounted_cash":335.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":671.6,"discounted_cash":671.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1343.2,"discounted_cash":1343.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5216-4","type":"NDC"}],"standard_charges":[{"gross_charge":323.3,"discounted_cash":323.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":646.6,"discounted_cash":646.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1293.2,"discounted_cash":1293.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76125-792-10","type":"NDC"}],"standard_charges":[{"gross_charge":259.67,"discounted_cash":259.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":519.34,"discounted_cash":519.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1038.68,"discounted_cash":1038.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68982-643-02","type":"NDC"}],"standard_charges":[{"gross_charge":286.4,"discounted_cash":286.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":572.8,"discounted_cash":572.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1145.6,"discounted_cash":1145.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68982-643-01","type":"NDC"}],"standard_charges":[{"gross_charge":275.5,"discounted_cash":275.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":551.0,"discounted_cash":551.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1102.0,"discounted_cash":1102.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"13533-692-72","type":"NDC"}],"standard_charges":[{"gross_charge":323.3,"discounted_cash":323.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":646.6,"discounted_cash":646.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1293.2,"discounted_cash":1293.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5216-8","type":"NDC"}],"standard_charges":[{"gross_charge":246.5,"discounted_cash":246.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":493.0,"discounted_cash":493.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":986.0,"discounted_cash":986.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5216-7","type":"NDC"}],"standard_charges":[{"gross_charge":260.8,"discounted_cash":260.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":521.6,"discounted_cash":521.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1043.2,"discounted_cash":1043.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"13533-692-71","type":"NDC"}],"standard_charges":[{"gross_charge":323.23,"discounted_cash":323.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":646.46,"discounted_cash":646.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1292.92,"discounted_cash":1292.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-651-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323-651-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.06,"discounted_cash":71.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-651-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323-651-04","type":"NDC"}],"standard_charges":[{"gross_charge":70.53,"discounted_cash":70.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-854-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457-854-00","type":"NDC"}],"standard_charges":[{"gross_charge":51.55,"discounted_cash":51.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"67457-854-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.06,"discounted_cash":42.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN [39477]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457-854-04","type":"NDC"}],"standard_charges":[{"gross_charge":84.12,"discounted_cash":84.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ADENOSINE 24 MCG/ML IN 500 ML BAG [40838704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"9999-8387-04","type":"NDC"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":163.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-651-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323-651-00","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-651-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0944-0493-02","type":"NDC"}],"standard_charges":[{"gross_charge":254.6,"discounted_cash":254.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":509.2,"discounted_cash":509.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1018.4,"discounted_cash":1018.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0944-0493-01","type":"NDC"}],"standard_charges":[{"gross_charge":267.1,"discounted_cash":267.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":534.2,"discounted_cash":534.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1068.4,"discounted_cash":1068.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBENDAZOLE 200 MG PO TABS [8979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72205-051-08","type":"NDC"}],"standard_charges":[{"gross_charge":30.66,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":61.31,"discounted_cash":61.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ADVANCED PROBIOTIC PO CAPS [126675]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"40985-27505","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR [120799]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9354","type":"HCPCS"},{"code":"50242-088-01","type":"NDC"}],"standard_charges":[{"gross_charge":12389.17,"discounted_cash":12389.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN [38703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323-651-02","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"}]},{"description":"ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN [14468]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0504-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"0143-9386-01","type":"NDC"}],"standard_charges":[{"gross_charge":78.61,"discounted_cash":78.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":51.1,"discounted_cash":51.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0137","type":"HCPCS"},{"code":"0143-9386-10","type":"NDC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":79.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":51.35,"discounted_cash":51.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"36000-306-60","type":"NDC"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323-434-00","type":"NDC"}],"standard_charges":[{"gross_charge":50.8,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 10 MG/ML IV SOLN [108021]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"67457-940-10","type":"NDC"}],"standard_charges":[{"gross_charge":61.6,"discounted_cash":61.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 120 MG RE SUPP [103]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-732-33","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SOLN [100]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-1971-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0296-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0939-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0966-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0966-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-061-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACEBUTOLOL HCL 200 MG PO CAPS [8939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-050-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ACEBUTOLOL HCL 200 MG PO CAPS [8939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-050-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ABACAVIR SULFATE 20 MG/ML PO SOLN [24439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"31722-562-24","type":"NDC"}],"standard_charges":[{"gross_charge":47.29,"discounted_cash":47.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":94.58,"discounted_cash":94.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ABACAVIR SULFATE 20 MG/ML PO SOLN [24439]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-405-24","type":"NDC"}],"standard_charges":[{"gross_charge":61.06,"discounted_cash":61.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":122.12,"discounted_cash":122.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ABACAVIR SULFATE 300 MG PO TABS [24438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6874-04","type":"NDC"}],"standard_charges":[{"gross_charge":31.53,"discounted_cash":31.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":63.06,"discounted_cash":63.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ABACAVIR SULFATE 300 MG PO TABS [24438]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-021-21","type":"NDC"}],"standard_charges":[{"gross_charge":25.98,"discounted_cash":25.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":51.95,"discounted_cash":51.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS [39301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-362-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABACAVIR-LAMIVUDINE-ZIDOVUDINE 300-150-300 MG PO TABS [29167]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-286-07","type":"NDC"}],"standard_charges":[{"gross_charge":121.56,"discounted_cash":121.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"ABATACEPT 125 MG/ML SC SOAJ [131449]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0129","type":"HCPCS"},{"code":"0003-2188-51","type":"NDC"}],"standard_charges":[{"gross_charge":3882.86,"discounted_cash":3882.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 125 MG"}]},{"description":"ABATACEPT 250 MG IV SOLR [70287]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0129","type":"HCPCS"},{"code":"0003-2187-13","type":"NDC"}],"standard_charges":[{"gross_charge":4564.54,"discounted_cash":4564.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ABIRATERONE ACETATE 250 MG PO TABS [109776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-489-07","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"}]},{"description":"ABLYSINOL IA SOLN [139313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-105-02","type":"NDC"}],"standard_charges":[{"gross_charge":5045.71,"discounted_cash":5045.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ABLYSINOL IA SOLN [139313]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"54288-105-15","type":"NDC"}],"standard_charges":[{"gross_charge":4985.08,"discounted_cash":4985.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ABOBOTULINUMTOXINA 300 UNITS IM SOLR [106761]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0586","type":"HCPCS"},{"code":"15054-0530-6","type":"NDC"}],"standard_charges":[{"gross_charge":2759.92,"discounted_cash":2759.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ABOBOTULINUMTOXINA 500 UNITS IM SOLR [99465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0586","type":"HCPCS"},{"code":"15054-0500-1","type":"NDC"}],"standard_charges":[{"gross_charge":5649.57,"discounted_cash":5649.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 UNITS"}]},{"description":"ACEBUTOLOL HCL 200 MG PO CAPS [8939]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1200-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN [16825]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"0942-0641-03","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ACARBOSE 50 MG PO TABS [15895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-759-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ACARBOSE 50 MG PO TABS [15895]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0141-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ACAMPROSATE CALCIUM 333 MG PO TBEC [39720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-121-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 333 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 666 MG"}]},{"description":"ACAMPROSATE CALCIUM 333 MG PO TBEC [39720]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-6333-80","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 333 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 666 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-061-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 500 MG PO TABS [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0488-28","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 500 MG PO TABS [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6720-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 500 MG PO TABS [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50580-449-35","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 650 MG RE SUPP [105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-730-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ACETAMINOPHEN 650 MG RE SUPP [105]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-730-32","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ACETAMINOPHEN EXTRA STRENGTH 500 MG PO TABS [20544]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6720-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 80 MG PO CHEW [99]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-5791-46","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 160 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 320 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN [133542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-056-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20.3 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN [133542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6820-76","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20.3 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN [133542]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66689-056-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20.3 ML"}]},{"description":"ACETAMINOPHEN 500 MG PO TABS [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0449-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SUSP [8943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68094-587-58","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1327-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG PO TABS [101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71399-8014-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 500 MG PO TABS [102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0045-0449-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"}]},{"description":"ACETAMINOPHEN 325 MG RE SUPP [104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-2116-2","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 325 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 650 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"ALUMINUM POTASSIUM SULFATE N/A POWD [21429]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24357-300-30","type":"NDC"}],"standard_charges":[{"gross_charge":413.88,"discounted_cash":413.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76125-792-11","type":"NDC"}],"standard_charges":[{"gross_charge":259.7,"discounted_cash":259.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":519.4,"discounted_cash":519.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1038.8,"discounted_cash":1038.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALLOPURINOL 100 MG PO TABS [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5543-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALLOPURINOL 100 MG PO TABS [310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-156-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALLOPURINOL 300 MG PO TABS [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALLOPURINOL 300 MG PO TABS [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-5544-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALISKIREN FUMARATE 150 MG PO TABS [78653]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70839-150-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.19,"discounted_cash":49.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":98.37,"discounted_cash":98.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"ALLOPURINOL 300 MG PO TABS [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-135-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALLOPURINOL 300 MG PO TABS [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-350-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALLOPURINOL 300 MG PO TABS [311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53489-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"ALLOPURINOL SODIUM 500 MG IV SOLR [25408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"65219-380-30","type":"NDC"}],"standard_charges":[{"gross_charge":6233.47,"discounted_cash":6233.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALOSETRON HCL 0.5 MG PO TABS [37664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0295-13","type":"NDC"}],"standard_charges":[{"gross_charge":112.29,"discounted_cash":112.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":224.57,"discounted_cash":224.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALFUZOSIN HCL ER 10 MG PO TB24 [36982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"47335-956-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"ALFUZOSIN HCL ER 10 MG PO TB24 [36982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-155-19","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG/5ML PO SYRP [252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"99999102610","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUTEROL SULFATE ER 4 MG PO TB12 [34090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-4122-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0173-0682-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 G"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS [17837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69097-142-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.7 G"}]},{"description":"ALCOHOL, USP 70 % N/A SOLN [8992]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41622-0331-43","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ALCOHOL, USP 70 % N/A SOLN [8992]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-0778-34","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"ALENDRONATE SODIUM 10 MG PO TABS [15661]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-340-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":85.75,"discounted_cash":85.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALENDRONATE SODIUM 70 MG PO TABS [29048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-342-14","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALENDRONATE SODIUM 70 MG PO TABS [29048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-131-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALENDRONATE SODIUM 70 MG PO TABS [29048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-131-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALENDRONATE SODIUM 70 MG PO TABS [29048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69543-131-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 MG"}]},{"description":"ALOSETRON HCL 0.5 MG PO TABS [37664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-819-11","type":"NDC"}],"standard_charges":[{"gross_charge":28.13,"discounted_cash":28.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":56.25,"discounted_cash":56.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALOSETRON HCL 0.5 MG PO TABS [37664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-453-03","type":"NDC"}],"standard_charges":[{"gross_charge":30.89,"discounted_cash":30.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":61.77,"discounted_cash":61.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM ER 0.5 MG PO TB24 [35864]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-454-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"ALPRAZOLAM ER 1 MG PO TB24 [35865]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0009-0059-07","type":"NDC"}],"standard_charges":[{"gross_charge":21.38,"discounted_cash":21.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.75,"discounted_cash":42.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":85.49,"discounted_cash":85.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":128.24,"discounted_cash":128.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"}]},{"description":"ALPROSTADIL 500 MCG/ML IJ SOLN [9001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"0009-3169-01","type":"NDC"}],"standard_charges":[{"gross_charge":205.6,"discounted_cash":205.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ALPROSTADIL 500 MCG/ML IJ SOLN [9001]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0270","type":"HCPCS"},{"code":"0009-3169-06","type":"NDC"}],"standard_charges":[{"gross_charge":970.84,"discounted_cash":970.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ALTEPLASE 1 MG/ML IJ [408101]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"9999-5461-10","type":"NDC"}],"standard_charges":[{"gross_charge":574.43,"discounted_cash":574.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALTEPLASE 100 MG IV SOLR [9002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242-085-25","type":"NDC"}],"standard_charges":[{"gross_charge":23877.34,"discounted_cash":23877.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ALTEPLASE 100 MG IV SOLR [9002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242-085-27","type":"NDC"}],"standard_charges":[{"gross_charge":25914.85,"discounted_cash":25914.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 81 MG"}]},{"description":"ALTEPLASE 13 MG SYRINGE [408903301]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"9999-6004-20","type":"NDC"}],"standard_charges":[{"gross_charge":4191.49,"discounted_cash":4191.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 MG"}]},{"description":"ALTEPLASE 2 MG IJ SOLR [31310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50242-041-64","type":"NDC"}],"standard_charges":[{"gross_charge":1178.16,"discounted_cash":1178.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALTEPLASE 50 MG IV SOLR [9003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242-044-13","type":"NDC"}],"standard_charges":[{"gross_charge":16009.34,"discounted_cash":16009.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP [9009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-0630-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUM HYDROXIDE-MAG CARBONATE 95-358 MG/15ML PO SUSP [24314]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7727-14","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":6.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ALUM HYDROXIDE-MAG CARBONATE 160-105 MG PO CHEW [9016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"46122-150-78","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CHEWABLE TABLET"}]},{"description":"ALUM HYDROXIDE-MAG CARBONATE 160-105 MG PO CHEW [9016]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0135-0098-26","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CHEWABLE TABLET"}]},{"description":"ALUM AMMONIUM (BULK) N/A POWD [345]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0395-0049-12","type":"NDC"}],"standard_charges":[{"gross_charge":79.56,"discounted_cash":79.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 340 G"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP [9009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1082-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALPRAZOLAM 1 MG PO TABS [326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3721-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP [9009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57896-639-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP [9009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-6833-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP [9009]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17856-6764-1","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALBUTEROL SULFATE 2 MG/5ML PO SYRP [252]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50383-740-16","type":"NDC"}],"standard_charges":[{"gross_charge":272.45,"discounted_cash":272.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":272.45,"discounted_cash":272.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":272.45,"discounted_cash":272.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALOSETRON HCL 0.5 MG PO TABS [37664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-248-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.55,"discounted_cash":20.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":41.09,"discounted_cash":41.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ALPRAZOLAM 0.25 MG PO TABS [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-1061-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALPRAZOLAM 0.25 MG PO TABS [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51991-704-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALPRAZOLAM 0.25 MG PO TABS [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-377-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALPRAZOLAM 0.25 MG PO TABS [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-377-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALPRAZOLAM 1 MG PO TABS [326]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2031-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALPRAZOLAM 0.25 MG PO TABS [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-676-99","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALPRAZOLAM 0.25 MG PO TABS [324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-676-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG PO TABS [253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70710-1061-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [8981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76125-792-25","type":"NDC"}],"standard_charges":[{"gross_charge":210.99,"discounted_cash":210.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":421.98,"discounted_cash":421.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":843.96,"discounted_cash":843.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76179-025-01","type":"NDC"}],"standard_charges":[{"gross_charge":265.75,"discounted_cash":265.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":531.5,"discounted_cash":531.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1063.0,"discounted_cash":1063.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76179-025-02","type":"NDC"}],"standard_charges":[{"gross_charge":265.75,"discounted_cash":265.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":531.5,"discounted_cash":531.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1063.0,"discounted_cash":1063.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76179-025-03","type":"NDC"}],"standard_charges":[{"gross_charge":253.25,"discounted_cash":253.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":506.5,"discounted_cash":506.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1013.0,"discounted_cash":1013.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN [4088981]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"76179-025-04","type":"NDC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":263.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":526.0,"discounted_cash":526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1052.0,"discounted_cash":1052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN [8982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5218-4","type":"NDC"}],"standard_charges":[{"gross_charge":253.0,"discounted_cash":253.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":506.0,"discounted_cash":506.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1012.0,"discounted_cash":1012.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-8270-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0378-8270-93","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-395-79","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-395-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-200-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-200-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-200-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG PO TABS [253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-949-25","type":"NDC"}],"standard_charges":[{"gross_charge":28.45,"discounted_cash":28.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":56.9,"discounted_cash":56.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG PO TABS [253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-657-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.61,"discounted_cash":28.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":57.22,"discounted_cash":57.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUTEROL SULFATE 2 MG PO TABS [253]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-657-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN [8982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5218-0","type":"NDC"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":494.0,"discounted_cash":494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":988.0,"discounted_cash":988.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU HIGH DOSE [40890068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0487-9901-30","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU [250]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76204-200-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU HIGH DOSE [40890068]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7611","type":"HCPCS"},{"code":"0487-9901-30","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN [8982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5214-9","type":"NDC"}],"standard_charges":[{"gross_charge":245.5,"discounted_cash":245.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":491.0,"discounted_cash":491.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":982.0,"discounted_cash":982.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN (APHERESIS) [4088982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0944-0495-05","type":"NDC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN (APHERESIS) [4088982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44206-310-25","type":"NDC"}],"standard_charges":[{"gross_charge":268.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN (APHERESIS) [4088982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5214-1","type":"NDC"}],"standard_charges":[{"gross_charge":254.5,"discounted_cash":254.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":509.0,"discounted_cash":509.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":254.5,"discounted_cash":254.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"},{"gross_charge":1018.0,"discounted_cash":1018.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN (APHERESIS) [4088982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5214-3","type":"NDC"}],"standard_charges":[{"gross_charge":252.91,"discounted_cash":252.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN [8982]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"68516-5214-7","type":"NDC"}],"standard_charges":[{"gross_charge":273.33,"discounted_cash":273.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 G"},{"gross_charge":546.66,"discounted_cash":546.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 G"},{"gross_charge":1093.32,"discounted_cash":1093.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"A+D PREVENT EX OINT [108270]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"41100-81124","type":"NDC"}],"standard_charges":[{"gross_charge":23.73,"discounted_cash":23.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 G"}]},{"description":"ATORVASTATIN CALCIUM 80 MG PO TABS [28645]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-2671-9","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"CANGRELOR TETRASODIUM 50 MG IV SOLR [128822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9460","type":"HCPCS"},{"code":"10122-620-01","type":"NDC"}],"standard_charges":[{"gross_charge":5356.46,"discounted_cash":5356.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CANGRELOR TETRASODIUM 50 MG IV SOLR [128822]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9460","type":"HCPCS"},{"code":"10122-620-10","type":"NDC"}],"standard_charges":[{"gross_charge":5944.91,"discounted_cash":5944.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CAPLACIZUMAB-YHDP 11 MG IJ KIT [139202]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9047","type":"HCPCS"},{"code":"58468-0225-1","type":"NDC"}],"standard_charges":[{"gross_charge":31804.96,"discounted_cash":31804.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 MG"}]},{"description":"CAPSAICIN 0.025 % EX CREA [1350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-2525-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CAPTOPRIL 12.5 MG PO TABS [9401]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7105-61","type":"NDC"}],"standard_charges":[{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 25 MG PO TABS [9402]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-315-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CANDIDA ALBICANS SKN TST ANTGN ID SOLN [17524]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"99999300710","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"CAPTOPRIL 50 MG PO TABS [9403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-8075-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CAPTOPRIL 50 MG PO TABS [9403]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"27241-162-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARBACHOL 0.01 % IO SOLN [19704]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0023-15","type":"NDC"}],"standard_charges":[{"gross_charge":119.91,"discounted_cash":119.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"CARBAMAZEPINE 100 MG/5ML PO SUSP [1356]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70954-240-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":13.95,"discounted_cash":13.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":18.6,"discounted_cash":18.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CARBAMAZEPINE 200 MG PO TABS [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6172-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CANDESARTAN CILEXETIL 4 MG PO TABS [23229]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-114-07","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN [140446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"80830-2363-1","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG PO TABS [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-4306-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG PO TABS [11046]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-2500-91","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN [23063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0145-0628-05","type":"NDC"}],"standard_charges":[{"gross_charge":40.9,"discounted_cash":40.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 222 ML"}]},{"description":"CANAGLIFLOZIN 100 MG PO TABS [121551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50458-140-30","type":"NDC"}],"standard_charges":[{"gross_charge":117.98,"discounted_cash":117.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":353.92,"discounted_cash":353.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CANAKINUMAB 150 MG/ML SC SOLN [135126]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0638","type":"HCPCS"},{"code":"0078-0734-61","type":"NDC"}],"standard_charges":[{"gross_charge":34382.73,"discounted_cash":34382.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":68765.45,"discounted_cash":68765.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CANDESARTAN CILEXETIL 16 MG PO TABS [23231]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3231-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CANDESARTAN CILEXETIL 16 MG PO TABS [23231]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-660-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CANDESARTAN CILEXETIL 4 MG PO TABS [23229]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3224-77","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CANDESARTAN CILEXETIL 32 MG PO TABS [23232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"33342-117-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CARBAMAZEPINE 200 MG PO TABS [1357]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0183-0","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CANDESARTAN CILEXETIL 32 MG PO TABS [23232]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-3232-77","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 32 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 MG"}]},{"description":"CARBAMAZEPINE ER 100 MG PO TB12 [27634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-8016-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51862-856-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-518-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367-339-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 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[9408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-9703-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG PO TABS [9408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6238-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG PO TABS 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[9408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-094-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG PO TABS [9408]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-094-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG PO TBDP 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[36136]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-5637-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA-ENTACAPONE 12.5-50-200 MG PO TABS [36135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0781-5613-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA-ENTACAPONE 12.5-50-200 MG PO TABS [36135]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0078-0407-05","type":"NDC"}],"standard_charges":[{"gross_charge":46.88,"discounted_cash":46.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-457-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR [26371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16729-079-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA ER 48.75-195 MG PO CPCR [127436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64896-663-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.32,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"CARBIDOPA-LEVODOPA ER 36.25-145 MG PO CPCR [127435]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64896-662-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.32,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"CARBIDOPA-LEVODOPA ER 23.75-95 MG PO CPCR [127434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64896-661-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.32,"discounted_cash":24.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":48.64,"discounted_cash":48.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"},{"gross_charge":72.96,"discounted_cash":72.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 CAPSULE"},{"gross_charge":97.28,"discounted_cash":97.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 CAPSULE"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0228-2539-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 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[27635]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-6023-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CARBAMAZEPINE ER 300 MG PO CP12 [27633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29033-004-12","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG PO TABS [9407]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CARBIDOPA-LEVODOPA 10-100 MG PO TABS [9406]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-517-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 TABLET"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 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[1359]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42037-10479","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBAMAZEPINE ER 300 MG PO CP12 [27633]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-409-32","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"CARBON C 14 [4089928]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"HARM","type":"RC"},{"code":"9999-3018-10","type":"NDC"}],"standard_charges":[{"gross_charge":1695.14,"discounted_cash":1695.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MICROCURIE"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN [1312]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"65219-630-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":72.34,"discounted_cash":72.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 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[9161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1552-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 CAPSULE"}]},{"description":"BUTALBITAL-ASPIRIN-CAFFEINE 50-325-40 MG PO CAPS [9161]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29033-215-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 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MG"},{"gross_charge":51.25,"discounted_cash":51.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":102.49,"discounted_cash":102.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN [9334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1626-02","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":52.02,"discounted_cash":52.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN [9334]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1626-21","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":55.82,"discounted_cash":55.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"CABERGOLINE 0.5 MG PO TABS [19226]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-823-73","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"CAFFEINE 200 MG PO TABS [1259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-457-73","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CAFFEINE 200 MG PO TABS [1259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62011-0340-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN [1262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2502-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.02,"discounted_cash":59.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":118.04,"discounted_cash":118.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN [1262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0517-2502-10","type":"NDC"}],"standard_charges":[{"gross_charge":215.11,"discounted_cash":215.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":215.11,"discounted_cash":215.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CALCIPOTRIENE 0.005 % EX CREA [16034]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-7117-35","type":"NDC"}],"standard_charges":[{"gross_charge":693.72,"discounted_cash":693.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CALCIPOTRIENE 0.005 % EX OINT [12244]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"66993-878-61","type":"NDC"}],"standard_charges":[{"gross_charge":1882.67,"discounted_cash":1882.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 G"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN [15738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49884-161-11","type":"NDC"}],"standard_charges":[{"gross_charge":359.52,"discounted_cash":359.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN [15738]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0823-6","type":"NDC"}],"standard_charges":[{"gross_charge":264.01,"discounted_cash":264.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 ML"}]},{"description":"CABAZITAXEL 60 MG/1.5ML IV SOLN [105644]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"0024-5824-11","type":"NDC"}],"standard_charges":[{"gross_charge":38721.31,"discounted_cash":38721.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS (EXEMPT NDCS) [4088958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69367-203-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS (EXEMPT NDCS) [4088958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-396-65","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-742-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 5 MG PO TABS [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24689-781-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 5 MG PO TABS [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-741-06","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 5 MG PO TABS [9324]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69584-091-50","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":73.5,"discounted_cash":73.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS (EXEMPT NDCS) [4088958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-396-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS (EXEMPT NDCS) [4088958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6938-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS (EXEMPT NDCS) [4088958]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1695-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCITRIOL 0.25 MCG PO CAPS [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"23155-662-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"BUTALBITAL-ACETAMINOPHEN 50-325 MG PO TABS (EXEMPT NDCS) [4088955]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2540-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BUSULFAN 6 MG/ML IV SOLN [24695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0594","type":"HCPCS"},{"code":"59148-070-90","type":"NDC"}],"standard_charges":[{"gross_charge":859.79,"discounted_cash":859.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUSULFAN 6 MG/ML IV SOLN [24695]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0594","type":"HCPCS"},{"code":"25021-241-10","type":"NDC"}],"standard_charges":[{"gross_charge":5192.45,"discounted_cash":5192.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CALCITRIOL 0.25 MCG PO CAPS [9350]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-967-88","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS [129599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29033-026-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP [136415]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0121-0766-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.87,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1250 MG"},{"gross_charge":9.87,"discounted_cash":9.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 625 MG"}]},{"description":"CALCIUM CARBONATE ANTACID 648 MG PO TABS [97552]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1206-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1296 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 648 MG"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN [1306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1631-10","type":"NDC"}],"standard_charges":[{"gross_charge":92.98,"discounted_cash":92.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":92.98,"discounted_cash":92.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN [1306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1631-40","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":62.86,"discounted_cash":62.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN [1306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4928-11","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":77.02,"discounted_cash":77.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN [1306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-4928-34","type":"NDC"}],"standard_charges":[{"gross_charge":115.42,"discounted_cash":115.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":115.42,"discounted_cash":115.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN [1306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"64253-900-30","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":72.82,"discounted_cash":72.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS [129599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24689-793-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCIUM CITRATE-VITAMIN D3 315-6.25 MG-MCG PO TABS [145351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"87701-40774","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM CITRATE-VITAMIN D3 315-6.25 MG-MCG PO TABS [145351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-081-76","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCIUM CHLORIDE 10 % IV SOLN [1306]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"76329-3304-1","type":"NDC"}],"standard_charges":[{"gross_charge":84.7,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":84.7,"discounted_cash":84.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS [129599]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16571-813-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1334 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2001 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 667 MG"}]},{"description":"CALCITRIOL 0.5 MCG PO CAPS [9351]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69452-208-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML IV SOLN [9348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"17478-931-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML IV SOLN [9348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0636","type":"HCPCS"},{"code":"17478-931-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.71,"discounted_cash":67.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":135.42,"discounted_cash":135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML IV SOLN [9348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-251-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.23,"discounted_cash":42.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML IV SOLN [9348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0636","type":"HCPCS"},{"code":"72266-251-01","type":"NDC"}],"standard_charges":[{"gross_charge":84.46,"discounted_cash":84.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":168.91,"discounted_cash":168.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML IV SOLN [9348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72266-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML IV SOLN [9348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0636","type":"HCPCS"},{"code":"72266-251-10","type":"NDC"}],"standard_charges":[{"gross_charge":63.57,"discounted_cash":63.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":127.13,"discounted_cash":127.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"CALCITRIOL 1 MCG/ML PO SOLN [16218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-3120-41","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":17.45,"discounted_cash":17.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"},{"gross_charge":26.17,"discounted_cash":26.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MCG"},{"gross_charge":34.89,"discounted_cash":34.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":43.62,"discounted_cash":43.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MCG"},{"gross_charge":52.34,"discounted_cash":52.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MCG"},{"gross_charge":61.06,"discounted_cash":61.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.75 MCG"},{"gross_charge":69.78,"discounted_cash":69.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"CALCIUM + D3 250-3 MG-MCG PO TABS [156972]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-1882-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"CALCITRIOL 1 MCG/ML PO SOLN [16218]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"30698-911-15","type":"NDC"}],"standard_charges":[{"gross_charge":21.39,"discounted_cash":21.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MCG"},{"gross_charge":42.78,"discounted_cash":42.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MCG"},{"gross_charge":64.17,"discounted_cash":64.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 MCG"},{"gross_charge":85.56,"discounted_cash":85.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MCG"},{"gross_charge":106.95,"discounted_cash":106.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 MCG"},{"gross_charge":128.34,"discounted_cash":128.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MCG"},{"gross_charge":149.72,"discounted_cash":149.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.75 MCG"},{"gross_charge":171.11,"discounted_cash":171.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MCG"}]},{"description":"CARBOPLATIN 150 MG/15ML IV SOLN [39266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-4246-01","type":"NDC"}],"standard_charges":[{"gross_charge":95.75,"discounted_cash":95.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBOPLATIN 150 MG/15ML IV SOLN [39266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-165-01","type":"NDC"}],"standard_charges":[{"gross_charge":115.01,"discounted_cash":115.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CEFTAZIDIME 1 G IJ SOLR [9474]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-235-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 1 G/10ML IJ (WET SOLR VIAL) [150437]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-127-66","type":"NDC"}],"standard_charges":[{"gross_charge":44.5,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME 2 G IV SOLR [27291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-5084-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.77,"discounted_cash":49.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR [128081]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0456-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":2479.75,"discounted_cash":2479.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR [127331]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0695","type":"HCPCS"},{"code":"67919-030-01","type":"NDC"}],"standard_charges":[{"gross_charge":1055.94,"discounted_cash":1055.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE 1 G IN NON-PF LIDOCAINE 1% IM INJ (350MG/ML) [4089487]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6148-4","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFTRIAXONE 2 G IN NON-PF LIDOCAINE 1% IM INJ (350MG/ML) [4089488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-7335-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFTRIAXONE 250 MG IN NON-PF LIDOCAINE 1% IM INJ (250MG/ML) [4089489]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6151-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"}]},{"description":"CEFTRIAXONE 500 MG IN STERILE WATER IM INJ (350MG/ML) [40809490]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6152-1","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-7335-13","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG/20ML IV (WET SOLR VIAL) [150436]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0712","type":"HCPCS"},{"code":"0456-0600-10","type":"NDC"}],"standard_charges":[{"gross_charge":1524.48,"discounted_cash":1524.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFPODOXIME PROXETIL 200 MG PO TABS [9469]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-096-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":20.89,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR [39522]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-548-88","type":"NDC"}],"standard_charges":[{"gross_charge":89.76,"discounted_cash":89.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEFDINIR 300 MG PO CAPS [22289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-177-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6146-0","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 1 G IJ SOLR [16369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6146-4","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFEPIME HCL 1 G IV SYRINGE [4082016369]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-121-66","type":"NDC"}],"standard_charges":[{"gross_charge":43.79,"discounted_cash":43.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFEPIME HCL 2 G IV SOLR [27311]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6246-0","type":"NDC"}],"standard_charges":[{"gross_charge":53.31,"discounted_cash":53.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFEPIME HCL 2 G IV SYRINGE [4082016371]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-122-67","type":"NDC"}],"standard_charges":[{"gross_charge":59.1,"discounted_cash":59.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR [142041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0693","type":"HCPCS"},{"code":"59630-266-01","type":"NDC"}],"standard_charges":[{"gross_charge":1215.85,"discounted_cash":1215.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":1823.78,"discounted_cash":1823.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"},{"gross_charge":2431.7,"discounted_cash":2431.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":911.89,"discounted_cash":911.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR [142041]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0693","type":"HCPCS"},{"code":"59630-266-10","type":"NDC"}],"standard_charges":[{"gross_charge":1401.75,"discounted_cash":1401.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":2102.62,"discounted_cash":2102.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"},{"gross_charge":2803.49,"discounted_cash":2803.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"},{"gross_charge":1051.31,"discounted_cash":1051.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CEFIXIME 400 MG PO CAPS [121884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-584-33","type":"NDC"}],"standard_charges":[{"gross_charge":64.04,"discounted_cash":64.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFOXITIN SODIUM 2 G/10ML IJ (WET SOLR VIAL) [150433]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-342-29","type":"NDC"}],"standard_charges":[{"gross_charge":59.36,"discounted_cash":59.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN SODIUM 2 G IV SOLR [9463]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-342-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.74,"discounted_cash":59.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN SODIUM 1 G/10ML IJ (WET SOLR VIAL) [150430]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-341-29","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR [9461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-341-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3209-95","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR [9461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-341-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFOTETAN DISODIUM 2 G IJ SOLR [9460]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-386-20","type":"NDC"}],"standard_charges":[{"gross_charge":135.61,"discounted_cash":135.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFOTETAN DISODIUM 1 G IJ SOLR [9458]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-385-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 G"},{"gross_charge":80.25,"discounted_cash":80.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFIXIME 400 MG PO CAPS [121884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-423-11","type":"NDC"}],"standard_charges":[{"gross_charge":55.49,"discounted_cash":55.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFIXIME 400 MG PO CAPS [121884]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-423-08","type":"NDC"}],"standard_charges":[{"gross_charge":67.03,"discounted_cash":67.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR [9461]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-341-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-702-95","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6149-0","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFTRIAXONE SODIUM 2 G IJ SOLR [9488]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6149-4","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEPHALEXIN 250 MG PO CAPS [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62756-293-88","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG PO CAPS [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-018-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG PO CAPS [9499]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-121-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-4177-73","type":"NDC"}],"standard_charges":[{"gross_charge":68.4,"discounted_cash":68.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24979-155-14","type":"NDC"}],"standard_charges":[{"gross_charge":49.2,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-441-01","type":"NDC"}],"standard_charges":[{"gross_charge":137.4,"discounted_cash":137.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR [9502]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-1068-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CEPHALEXIN 500 MG PO CAPS [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-3147-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG PO CAPS [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"49999-007-90","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CETUXIMAB 200 MG/100ML IV SOLN [108072]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733-958-23","type":"NDC"}],"standard_charges":[{"gross_charge":5124.25,"discounted_cash":5124.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CETUXIMAB 100 MG/50ML IV SOLN [37989]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733-948-23","type":"NDC"}],"standard_charges":[{"gross_charge":4398.5,"discounted_cash":4398.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CETIRIZINE HCL 5 MG/5ML PO SOLN [125052]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-626-26","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"CETAKLENZ EX LIQD [20104]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"96295-120-38","type":"NDC"}],"standard_charges":[{"gross_charge":36.28,"discounted_cash":36.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"CERTOLIZUMAB PEGOL 200 MG/ML SC PSKT [153896]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50474-710-81","type":"NDC"}],"standard_charges":[{"gross_charge":20633.25,"discounted_cash":20633.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":41266.5,"discounted_cash":41266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEPHALEXIN 500 MG PO CAPS [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-122-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEPHALEXIN 500 MG PO CAPS [9500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52959-031-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CERTOLIZUMAB PEGOL 2 X 200 MG SC KIT [91495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0717","type":"HCPCS"},{"code":"50474-700-62","type":"NDC"}],"standard_charges":[{"gross_charge":17824.55,"discounted_cash":17824.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR [39522]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-219-01","type":"NDC"}],"standard_charges":[{"gross_charge":149.4,"discounted_cash":149.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CELECOXIB 200 MG PO CAPS [24501]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42571-144-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"CEFTRIAXONE SODIUM 500 MG/1ML IJ (WET SOLR VIAL) - LIDOCAINE - <=1 YR [155837]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9858-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG PO TABS [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-699-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CELECOXIB 100 MG PO CAPS [24500]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-1516-1","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"}]},{"description":"CEFUROXIME SODIUM 750 MG IJ SOLR [1465]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-118-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 MG"}]},{"description":"CEFUROXIME SODIUM 1.5 G IV SOLR [27299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-119-20","type":"NDC"}],"standard_charges":[{"gross_charge":46.71,"discounted_cash":46.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"CENTRATEX 106-1 MG PO CAPS [96213]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"52747-800-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 CAPSULE"}]},{"description":"CEFUROXIME SODIUM 1.5 G IV SOLR [27299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9977-90","type":"NDC"}],"standard_charges":[{"gross_charge":60.32,"discounted_cash":60.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"CEFUROXIME AXETIL 250 MG PO TABS [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68180-302-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG PO TABS [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-215-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME AXETIL 250 MG PO TABS [9495]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"67877-215-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFUROXIME SODIUM 1.5 G IV SOLR [27299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9977-22","type":"NDC"}],"standard_charges":[{"gross_charge":56.44,"discounted_cash":56.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 G"}]},{"description":"CARBOPLATIN 150 MG/15ML IV SOLN [39266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-4246-81","type":"NDC"}],"standard_charges":[{"gross_charge":96.29,"discounted_cash":96.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CEFDINIR 125 MG/5ML PO SUSR [22290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-218-60","type":"NDC"}],"standard_charges":[{"gross_charge":118.08,"discounted_cash":118.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ SOLR [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-706-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CARDIOPLEGIA DEL NIDO FORMULA PF SOLN [141446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71285-0202-1","type":"NDC"}],"standard_charges":[{"gross_charge":509.03,"discounted_cash":509.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1052.8 ML"}]},{"description":"CARFILZOMIB 60 MG IV SOLR [117684]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9047","type":"HCPCS"},{"code":"76075-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":9164.65,"discounted_cash":9164.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CARIPRAZINE HCL 1.5 MG PO CAPS [130276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61874-115-11","type":"NDC"}],"standard_charges":[{"gross_charge":253.26,"discounted_cash":253.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":506.51,"discounted_cash":506.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":759.77,"discounted_cash":759.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 MG"},{"gross_charge":1013.02,"discounted_cash":1013.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"CARIPRAZINE HCL 1.5 MG PO CAPS [130276]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61874-115-20","type":"NDC"}],"standard_charges":[{"gross_charge":299.22,"discounted_cash":299.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":598.43,"discounted_cash":598.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":897.65,"discounted_cash":897.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 MG"},{"gross_charge":1196.86,"discounted_cash":1196.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"CARIPRAZINE HCL 3 MG PO CAPS [130277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61874-130-11","type":"NDC"}],"standard_charges":[{"gross_charge":120.85,"discounted_cash":120.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":241.7,"discounted_cash":241.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":362.54,"discounted_cash":362.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 MG"},{"gross_charge":483.39,"discounted_cash":483.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN [136417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"46122-195-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"CARIPRAZINE HCL 3 MG PO CAPS [130277]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61874-130-20","type":"NDC"}],"standard_charges":[{"gross_charge":149.61,"discounted_cash":149.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 MG"},{"gross_charge":299.22,"discounted_cash":299.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":448.83,"discounted_cash":448.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 MG"},{"gross_charge":598.43,"discounted_cash":598.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"CARISOPRODOL 350 MG PO TABS [1395]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50228-109-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 MG"}]},{"description":"CARMUSTINE IN POLIFEPROSAN 7.7 MG IL WAFR [21672]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"24338-050-08","type":"NDC"}],"standard_charges":[{"gross_charge":19773.59,"discounted_cash":19773.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-7295-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-144-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65862-144-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN [136417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0904-6329-46","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"CARBOPLATIN 150 MG/15ML IV SOLN [39266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-339-22","type":"NDC"}],"standard_charges":[{"gross_charge":179.18,"discounted_cash":179.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN [39267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-4248-01","type":"NDC"}],"standard_charges":[{"gross_charge":156.32,"discounted_cash":156.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN [39267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-4248-81","type":"NDC"}],"standard_charges":[{"gross_charge":156.32,"discounted_cash":156.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN [39267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"50742-447-45","type":"NDC"}],"standard_charges":[{"gross_charge":388.88,"discounted_cash":388.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN [39267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-166-01","type":"NDC"}],"standard_charges":[{"gross_charge":468.71,"discounted_cash":468.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN [39267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"55150-335-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.75,"discounted_cash":158.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN [39267]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-339-50","type":"NDC"}],"standard_charges":[{"gross_charge":307.25,"discounted_cash":307.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-4244-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOPLATIN 50 MG/5ML IV SOLN [39265]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"54288-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN [40055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"0703-4239-01","type":"NDC"}],"standard_charges":[{"gross_charge":193.04,"discounted_cash":193.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN [40055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"0703-4239-81","type":"NDC"}],"standard_charges":[{"gross_charge":263.96,"discounted_cash":263.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN [40055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729-295-12","type":"NDC"}],"standard_charges":[{"gross_charge":244.88,"discounted_cash":244.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN [40055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288-167-01","type":"NDC"}],"standard_charges":[{"gross_charge":610.28,"discounted_cash":610.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN [40055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150-386-01","type":"NDC"}],"standard_charges":[{"gross_charge":250.92,"discounted_cash":250.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN [40055]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"63323-172-60","type":"NDC"}],"standard_charges":[{"gross_charge":342.08,"discounted_cash":342.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-698-11","type":"NDC"}],"standard_charges":[{"gross_charge":1524.0,"discounted_cash":1524.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":3004.0,"discounted_cash":3004.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN [136417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0536-1387-92","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN [136417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-0403-70","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN [136417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-0403-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"CARBOXYMETHYLCELLULOSE SOD PF 0.5 % OP SOLN [136417]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0023-0403-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 DROP"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 DROP"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71839-137-10","type":"NDC"}],"standard_charges":[{"gross_charge":191.79,"discounted_cash":191.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":339.58,"discounted_cash":339.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-919-58","type":"NDC"}],"standard_charges":[{"gross_charge":204.84,"discounted_cash":204.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":365.68,"discounted_cash":365.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN [9413]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"43598-919-11","type":"NDC"}],"standard_charges":[{"gross_charge":1538.27,"discounted_cash":1538.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MCG"},{"gross_charge":3032.53,"discounted_cash":3032.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MCG"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-151-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL PHOSPHATE ER 40 MG PO CP24 [77666]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-665-83","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":19.06,"discounted_cash":19.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":38.12,"discounted_cash":38.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":76.23,"discounted_cash":76.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"CARVEDILOL PHOSPHATE ER 40 MG PO CP24 [77666]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-4715-3","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":23.7,"discounted_cash":23.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":47.39,"discounted_cash":47.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":94.78,"discounted_cash":94.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"CARVEDILOL PHOSPHATE ER 40 MG PO CP24 [77666]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"69784-715-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.34,"discounted_cash":12.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.68,"discounted_cash":24.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.35,"discounted_cash":49.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":98.69,"discounted_cash":98.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/100ML-% IV SOLN [133462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70092-1623-03","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/100ML-% IV SOLN [133462]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-023-48","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 G"}]},{"description":"CEFAZOLIN SODIUM 1 G IJ SOLR [1445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"44567-707-25","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN SODIUM 1 G IV SOLR [27297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-2585-01","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ SOLR [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-100-66","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ SOLR [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3450-95","type":"NDC"}],"standard_charges":[{"gross_charge":87.5,"discounted_cash":87.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN SODIUM 500 MG IJ SOLR [1448]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0781-3450-70","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN SODIUM 3 G IV SOLR [150789]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9140-25","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN SODIUM 3 G IJ SOLR [153540]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6266-5","type":"NDC"}],"standard_charges":[{"gross_charge":51.43,"discounted_cash":51.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SYRINGE [408400102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-102-70","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SYRINGE [408400102]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70092-1604-47","type":"NDC"}],"standard_charges":[{"gross_charge":97.29,"discounted_cash":97.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CEFAZOLIN SODIUM 10 G IJ SOLR [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"60505-6143-4","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN SODIUM 10 G IJ SOLR [1446]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"25021-102-69","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"CEFAZOLIN SODIUM 1 G IV SYRINGE [4081445]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"99999-102-69","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR [138151]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0264-3105-11","type":"NDC"}],"standard_charges":[{"gross_charge":138.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"CARVEDILOL PHOSPHATE ER 10 MG PO CP24 [77664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-3678-3","type":"NDC"}],"standard_charges":[{"gross_charge":30.88,"discounted_cash":30.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.76,"discounted_cash":61.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":123.51,"discounted_cash":123.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":247.01,"discounted_cash":247.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-094-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-164-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68462-164-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 12.5 MG PO TABS [15749]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"72888-036-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL PHOSPHATE ER 10 MG PO CP24 [77664]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"57664-663-83","type":"NDC"}],"standard_charges":[{"gross_charge":37.64,"discounted_cash":37.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":75.28,"discounted_cash":75.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":150.56,"discounted_cash":150.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":301.11,"discounted_cash":301.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"CARVEDILOL 3.125 MG PO TABS [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"76385-110-50","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"CARVEDILOL 3.125 MG PO TABS [18551]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68001-153-00","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.125 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 MG"}]},{"description":"BENZONATATE 100 MG PO CAPS [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-214-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZTROPINE MESYLATE 1 MG PO TABS [999]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2438-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZTROPINE MESYLATE 1 MG PO TABS [999]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2438-32","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"}]},{"description":"BENZTROPINE MESYLATE 1 MG/ML IJ SOLN [9259]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0143-9729-01","type":"NDC"}],"standard_charges":[{"gross_charge":351.23,"discounted_cash":351.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BETAMETHASONE DIPROPIONATE AUG 0.05 % EX CREA [9175]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51672-1310-3","type":"NDC"}],"standard_charges":[{"gross_charge":45.84,"discounted_cash":45.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 G"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0720-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":97.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":48.88,"discounted_cash":48.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0791-01","type":"NDC"}],"standard_charges":[{"gross_charge":92.72,"discounted_cash":92.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":46.36,"discounted_cash":46.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0517-0799-01","type":"NDC"}],"standard_charges":[{"gross_charge":97.75,"discounted_cash":97.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":48.88,"discounted_cash":48.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"62295-3018-2","type":"NDC"}],"standard_charges":[{"gross_charge":259.21,"discounted_cash":259.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":129.61,"discounted_cash":129.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP [9266]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71283-0620-2","type":"NDC"}],"standard_charges":[{"gross_charge":233.59,"discounted_cash":233.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 MG"},{"gross_charge":116.8,"discounted_cash":116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"}]},{"description":"BETAXOLOL HCL 0.25 % OP SUSP [19703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0065-0246-10","type":"NDC"}],"standard_charges":[{"gross_charge":1948.92,"discounted_cash":1948.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BETAXOLOL HCL 0.25 % OP SUSP [19703]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0078-0729-10","type":"NDC"}],"standard_charges":[{"gross_charge":2398.44,"discounted_cash":2398.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BETHANECHOL CHLORIDE 25 MG PO TABS [1044]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0512-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 5 MG PO TABS [1045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0527-1332-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 5 MG PO TABS [1045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0832-0510-00","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BENZONATATE 100 MG PO CAPS [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42806-714-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BENZONATATE 100 MG PO CAPS [988]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6564-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BELIMUMAB 400 MG IV SOLR [108843]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":7908.72,"discounted_cash":7908.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG RE SUPP [9219]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7045-12","type":"NDC"}],"standard_charges":[{"gross_charge":122.14,"discounted_cash":122.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 SUPPOSITORY"},{"gross_charge":122.14,"discounted_cash":122.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"},{"gross_charge":244.28,"discounted_cash":244.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 SUPPOSITORY"}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RE SUPP [24731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7040-01","type":"NDC"}],"standard_charges":[{"gross_charge":79.97,"discounted_cash":79.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 SUPPOSITORY"},{"gross_charge":159.93,"discounted_cash":159.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"}]},{"description":"BELLADONNA ALKALOIDS-OPIUM 16.2-60 MG RE SUPP [24731]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-7040-12","type":"NDC"}],"standard_charges":[{"gross_charge":149.48,"discounted_cash":149.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 SUPPOSITORY"},{"gross_charge":149.48,"discounted_cash":149.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 SUPPOSITORY"}]},{"description":"BENAZEPRIL HCL 10 MG PO TABS [9220]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-336-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BENAZEPRIL HCL 20 MG PO TABS [9221]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-753-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BENAZEPRIL HCL 5 MG PO TABS [9223]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-751-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":98.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BENZOIN EX LIQD [9243]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"40565-111-82","type":"NDC"}],"standard_charges":[{"gross_charge":162.14,"discounted_cash":162.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"BENZOCAINE-MENTHOL 6-10 MG MT LOZG [41085]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"78112-01266","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 EACH"}]},{"description":"BENZOCAINE-MENTHOL 20-0.5 % EX AERO [28048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51409-00722","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 78 G"}]},{"description":"BENZOCAINE-MENTHOL 20-0.5 % EX AERO [28048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16864-68003","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 G"}]},{"description":"BENZOCAINE-MENTHOL 20-0.5 % EX AERO [28048]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"16864-68002","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 G"}]},{"description":"BENZOCAINE 20 % MT GEL [19691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60640-8800-1","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 APPLICATION"}]},{"description":"BENZOCAINE 20 % MT AERO [135071]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0283-0679-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 G"}]},{"description":"BENZOCAINE 10 % MT GEL [19690]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50486-55032","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 G"}]},{"description":"BENDAMUSTINE HCL 100 MG/4ML IV SOLN [129976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9034","type":"HCPCS"},{"code":"63459-348-04","type":"NDC"}],"standard_charges":[{"gross_charge":7952.1,"discounted_cash":7952.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BENZOCAINE 20 % MT GEL [19691]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0283-0871-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 G"}]},{"description":"BETHANECHOL CHLORIDE 5 MG PO TABS [1045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"53746-571-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP [1090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"46122-703-26","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"BISOPROLOL FUMARATE 5 MG PO TABS [18288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-126-13","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BISOPROLOL FUMARATE 5 MG PO TABS [18288]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"62332-603-31","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MG PO TABS [18289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0707-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MG PO TABS [18289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-0505-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MG PO TABS [18289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-189-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 2.5-6.25 MG PO TABS [18291]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"42799-920-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MG PO TABS [18290]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-188-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR [134820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"55111-652-07","type":"NDC"}],"standard_charges":[{"gross_charge":558.67,"discounted_cash":558.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR [134820]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0583","type":"HCPCS"},{"code":"55111-652-37","type":"NDC"}],"standard_charges":[{"gross_charge":326.56,"discounted_cash":326.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BLEOMYCIN SULFATE 15 UNITS IJ SOLR [9289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-3154-01","type":"NDC"}],"standard_charges":[{"gross_charge":204.83,"discounted_cash":204.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":204.83,"discounted_cash":204.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BLEOMYCIN SULFATE 15 UNITS IJ SOLR [9289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"61703-332-18","type":"NDC"}],"standard_charges":[{"gross_charge":337.46,"discounted_cash":337.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":337.46,"discounted_cash":337.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BRENTUXIMAB VEDOTIN 50 MG IV SOLR [111348]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9042","type":"HCPCS"},{"code":"51144-050-01","type":"NDC"}],"standard_charges":[{"gross_charge":45733.0,"discounted_cash":45733.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BOSUTINIB 500 MG PO TABS [118003]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0069-0136-01","type":"NDC"}],"standard_charges":[{"gross_charge":1924.25,"discounted_cash":1924.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 MG"},{"gross_charge":1924.25,"discounted_cash":1924.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":3848.5,"discounted_cash":3848.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"BLINATUMOMAB 35 MCG IV SOLR [127278]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9039","type":"HCPCS"},{"code":"55513-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":15045.58,"discounted_cash":15045.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BLEOMYCIN SULFATE 30 UNITS IJ SOLR [17012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-107-20","type":"NDC"}],"standard_charges":[{"gross_charge":53.94,"discounted_cash":53.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":63.87,"discounted_cash":63.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP [1090]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-302-26","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"BLEOMYCIN SULFATE 30 UNITS IJ SOLR [17012]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0703-3155-01","type":"NDC"}],"standard_charges":[{"gross_charge":54.9,"discounted_cash":54.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":65.79,"discounted_cash":65.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BLEOMYCIN SULFATE 15 UNITS IJ SOLR [9289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"71288-106-10","type":"NDC"}],"standard_charges":[{"gross_charge":53.14,"discounted_cash":53.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":62.28,"discounted_cash":62.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BLEOMYCIN SULFATE 15 UNITS IJ SOLR [9289]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-136-10","type":"NDC"}],"standard_charges":[{"gross_charge":219.4,"discounted_cash":219.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UNITS"},{"gross_charge":219.4,"discounted_cash":219.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UNITS"}]},{"description":"BELIMUMAB 120 MG IV SOLR [108842]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0490","type":"HCPCS"},{"code":"49401-101-01","type":"NDC"}],"standard_charges":[{"gross_charge":4079.75,"discounted_cash":4079.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG PO TABS [13810]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24385-017-58","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 TABLET"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 TABLET"}]},{"description":"BISACODYL 5 MG PO TBEC [1079]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6407-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BETHANECHOL CHLORIDE 5 MG PO TABS [1045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64980-160-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BETHANECHOL CHLORIDE 5 MG PO TABS [1045]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-571-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":61.25,"discounted_cash":61.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"},{"gross_charge":122.5,"discounted_cash":122.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BEVACIZUMAB 100 MG/4ML IV SOLN [108065]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242-060-01","type":"NDC"}],"standard_charges":[{"gross_charge":5160.35,"discounted_cash":5160.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BEVACIZUMAB 400 MG/16ML IV SOLN [108066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242-061-01","type":"NDC"}],"standard_charges":[{"gross_charge":12778.01,"discounted_cash":12778.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN [140375]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513-206-01","type":"NDC"}],"standard_charges":[{"gross_charge":4389.06,"discounted_cash":4389.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN [140376]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513-207-01","type":"NDC"}],"standard_charges":[{"gross_charge":10858.22,"discounted_cash":10858.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"BEZLOTOXUMAB 1000 MG/40ML IV SOLN 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[120985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1109-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.14,"discounted_cash":44.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATRACURIUM BESYLATE 50 MG/5ML IV SOLN [120985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1109-11","type":"NDC"}],"standard_charges":[{"gross_charge":44.53,"discounted_cash":44.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY [135094]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"0409-1630-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":80.08,"discounted_cash":80.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60505-6226-0","type":"NDC"}],"standard_charges":[{"gross_charge":147.6,"discounted_cash":147.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60219-1748-2","type":"NDC"}],"standard_charges":[{"gross_charge":163.26,"discounted_cash":163.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"17478-215-02","type":"NDC"}],"standard_charges":[{"gross_charge":177.58,"discounted_cash":177.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0817-02","type":"NDC"}],"standard_charges":[{"gross_charge":245.31,"discounted_cash":245.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN [736]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0303-55","type":"NDC"}],"standard_charges":[{"gross_charge":297.63,"discounted_cash":297.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATRACURIUM BESYLATE 50 MG/5ML IV SOLN [120985]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71288-701-05","type":"NDC"}],"standard_charges":[{"gross_charge":46.12,"discounted_cash":46.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"AZITHROMYCIN 1 G PO PACK [15284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3051-1","type":"NDC"}],"standard_charges":[{"gross_charge":135.59,"discounted_cash":135.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":271.17,"discounted_cash":271.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"AZITHROMYCIN 1 G PO PACK [15284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3051-2","type":"NDC"}],"standard_charges":[{"gross_charge":128.61,"discounted_cash":128.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":257.22,"discounted_cash":257.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"BACLOFEN 10 MG PO TABS [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0603-2406-28","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 10 MG PO TABS [860]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-343-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 10 MG/5ML IT SOLN [108156]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70257-561-05","type":"NDC"}],"standard_charges":[{"gross_charge":2810.6,"discounted_cash":2810.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":5621.2,"discounted_cash":5621.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"}]},{"description":"BACLOFEN 20 MG PO TABS [861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0172-4097-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BACLOFEN 40 MG/20ML IT SOLN [108157]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"58281-563-02","type":"NDC"}],"standard_charges":[{"gross_charge":3233.2,"discounted_cash":3233.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":6466.4,"discounted_cash":6466.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":12932.8,"discounted_cash":12932.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"BACLOFEN 40000 MCG/20ML IT SOSY [135075]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"66794-157-01","type":"NDC"}],"standard_charges":[{"gross_charge":2137.46,"discounted_cash":2137.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":4274.92,"discounted_cash":4274.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 MG"},{"gross_charge":8549.84,"discounted_cash":8549.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 MG"}]},{"description":"BCG LIVE 50 MG IS SUSR [21570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0052-0602-02","type":"NDC"}],"standard_charges":[{"gross_charge":1088.35,"discounted_cash":1088.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BCG LIVE 50 MG IS SUSR [21570]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0052-0602-01","type":"NDC"}],"standard_charges":[{"gross_charge":1024.4,"discounted_cash":1024.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BASAGLAR KWIKPEN 100 UNIT/ML SC SOPN [132809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-7715-59","type":"NDC"}],"standard_charges":[{"gross_charge":346.12,"discounted_cash":346.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"BASAGLAR KWIKPEN 100 UNIT/ML SC SOPN [132809]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"0002-7715-01","type":"NDC"}],"standard_charges":[{"gross_charge":314.3,"discounted_cash":314.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"BARIUM SULFATE 60 % PO SUSP [12748]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"32909-187-02","type":"NDC"}],"standard_charges":[{"gross_charge":38.34,"discounted_cash":38.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 355 ML"}]},{"description":"BARICITINIB 2 MG PO TABS [137400]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0002-4182-30","type":"NDC"}],"standard_charges":[{"gross_charge":583.34,"discounted_cash":583.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":583.34,"discounted_cash":583.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":1166.68,"discounted_cash":1166.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":1166.68,"discounted_cash":1166.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"BALSALAZIDE DISODIUM 750 MG PO CAPS [29299]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0054-0079-28","type":"NDC"}],"standard_charges":[{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2250 MG"}]},{"description":"BACTERIOSTATIC WATER(BENZ ALC) IJ SOLN [14979]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-3977-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BACLOFEN-GABAPENTIN-DICLOFENAC-TETRACAINE EX GEL [408002]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"9999-9999-98","type":"NDC"}],"standard_charges":[{"gross_charge":898.8,"discounted_cash":898.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 G"}]},{"description":"BECLOMETHASONE DIPROP HFA 40 MCG/ACT IN AERB [134066]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59310-302-40","type":"NDC"}],"standard_charges":[{"gross_charge":1294.71,"discounted_cash":1294.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.6 G"}]},{"description":"BACITRACIN-POLYMYXIN B OP OINT [19584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-555-55","type":"NDC"}],"standard_charges":[{"gross_charge":25.35,"discounted_cash":25.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM EX OINT [855]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"58980-012-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 G"}]},{"description":"AZITHROMYCIN 1 G PO PACK [15284]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3051-5","type":"NDC"}],"standard_charges":[{"gross_charge":128.61,"discounted_cash":128.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"},{"gross_charge":257.22,"discounted_cash":257.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 G"}]},{"description":"AZITHROMYCIN 100 MG/5ML PO SUSR [15796]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3110-1","type":"NDC"}],"standard_charges":[{"gross_charge":94.77,"discounted_cash":94.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":94.77,"discounted_cash":94.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"AZITHROMYCIN 200 MG/5ML PO SUSR [15797]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"59762-3120-1","type":"NDC"}],"standard_charges":[{"gross_charge":86.31,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":86.31,"discounted_cash":86.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"AZITHROMYCIN 250 MG PO TABS [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-742-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":58.8,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 250 MG PO TABS [20943]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-742-65","type":"NDC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 MG"},{"gross_charge":58.8,"discounted_cash":58.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR [21063]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"63323-398-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT [13818]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0536-1263-28","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 G"}]},{"description":"BACITRACIN 500 UNIT/GM OP OINT [852]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-4022-35","type":"NDC"}],"standard_charges":[{"gross_charge":528.15,"discounted_cash":528.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT [850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"45802-060-70","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT [850]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7402-67","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"AZTREONAM 2 G/10ML IJ (WET SOLR VIAL) [150425]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0409-0830-01","type":"NDC"}],"standard_charges":[{"gross_charge":323.43,"discounted_cash":323.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BACITRACIN-POLYMYXIN B OP OINT [19584]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"17478-238-35","type":"NDC"}],"standard_charges":[{"gross_charge":74.05,"discounted_cash":74.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 G"}]},{"description":"AZTREONAM 1 G/10ML IJ (WET SOLR VIAL) [150420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0457","type":"HCPCS"},{"code":"0409-0829-01","type":"NDC"}],"standard_charges":[{"gross_charge":171.18,"discounted_cash":171.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 G"}]},{"description":"AZTREONAM 1 G/10ML IJ (WET SOLR VIAL) [150420]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-0829-01","type":"NDC"}],"standard_charges":[{"gross_charge":85.59,"discounted_cash":85.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"}]},{"description":"AZITHROMYCIN 600 MG PO TABS [17387]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50111-789-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1200 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 600 MG"}]},{"description":"BRIMONIDINE TARTRATE 0.1 % OP SOLN [70262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-9321-05","type":"NDC"}],"standard_charges":[{"gross_charge":1149.12,"discounted_cash":1149.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.1 % OP SOLN [70262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60505-0577-1","type":"NDC"}],"standard_charges":[{"gross_charge":632.7,"discounted_cash":632.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN 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[105634]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-462-17","type":"NDC"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":52.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [123595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1165-19","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [123595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1582-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.02,"discounted_cash":47.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [123595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1582-18","type":"NDC"}],"standard_charges":[{"gross_charge":47.02,"discounted_cash":47.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [123595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-171-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [123595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-472-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"55150-249-50","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN [1222]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"63323-465-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":56.58,"discounted_cash":56.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 MG"}]},{"description":"BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN 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[112861]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0666","type":"HCPCS"},{"code":"65250-133-10","type":"NDC"}],"standard_charges":[{"gross_charge":1149.16,"discounted_cash":1149.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":2298.32,"discounted_cash":2298.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":804.42,"discounted_cash":804.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"BUPROPION HCL ER (SR) 100 MG PO TB12 [18385]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"43547-288-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0093-0054-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1150-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0378-1150-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"29300-245-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"64380-742-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":30.63,"discounted_cash":30.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUSPIRONE HCL 10 MG PO TABS [9323]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"51079-986-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [123595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0409-1165-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPROPION HCL ER (SR) 150 MG PO TB12 [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3541-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL ER (SR) 150 MG PO TB12 [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3541-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL ER (SR) 150 MG PO TB12 [18386]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-3541-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":16.34,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 MG"}]},{"description":"BUPROPION HCL ER (XL) 150 MG PO TB24 [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-7084-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 150 MG PO TB24 [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-140-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 150 MG PO TB24 [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50268-140-13","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 150 MG PO TB24 [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-782-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 300 MG PO TB24 [36776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-252-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 300 MG PO TB24 [36776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68084-252-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 300 MG PO TB24 [36776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-793-21","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 300 MG PO TB24 [36776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-793-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 300 MG PO TB24 [36776]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0904-6573-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BUPROPION HCL ER (XL) 150 MG PO TB24 [36775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"60687-782-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 MG"}]},{"description":"BRIMONIDINE TARTRATE 0.1 % OP SOLN [70262]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0023-9321-15","type":"NDC"}],"standard_charges":[{"gross_charge":3483.72,"discounted_cash":3483.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN [123595]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0143-9332-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323-466-08","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0093-6816-19","type":"NDC"}],"standard_charges":[{"gross_charge":65.81,"discounted_cash":65.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0115-1689-74","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-524-79","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP [28775]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"60687-524-83","type":"NDC"}],"standard_charges":[{"gross_charge":20.07,"discounted_cash":20.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"}]},{"description":"BUDESONIDE 1 MG/2ML IN SUSP [88223]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-321-32","type":"NDC"}],"standard_charges":[{"gross_charge":21.19,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"BUDESONIDE 1 MG/2ML IN SUSP [88223]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-321-53","type":"NDC"}],"standard_charges":[{"gross_charge":18.03,"discounted_cash":18.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"}]},{"description":"BUDESONIDE 180 MCG/ACT IN AEPB [96977]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0916-12","type":"NDC"}],"standard_charges":[{"gross_charge":1581.89,"discounted_cash":1581.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BUDESONIDE 180 MCG/ACT IN AEPB [96977]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61269-518-12","type":"NDC"}],"standard_charges":[{"gross_charge":1546.58,"discounted_cash":1546.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BUDESONIDE 3 MG PO CPEP [130414]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-9855-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE 3 MG PO CPEP [130414]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"65162-778-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-318-53","type":"NDC"}],"standard_charges":[{"gross_charge":46.76,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESONIDE 3 MG PO CPEP [130414]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68382-720-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 MG"},{"gross_charge":36.75,"discounted_cash":36.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE 90 MCG/ACT IN AEPB [96976]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0917-06","type":"NDC"}],"standard_charges":[{"gross_charge":1028.36,"discounted_cash":1028.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BUDESONIDE ER 9 MG PO TB24 [137620]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0591-2510-30","type":"NDC"}],"standard_charges":[{"gross_charge":143.43,"discounted_cash":143.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 MG"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO [81454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0370-28","type":"NDC"}],"standard_charges":[{"gross_charge":360.76,"discounted_cash":360.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 G"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO [81454]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-7370-20","type":"NDC"}],"standard_charges":[{"gross_charge":1486.68,"discounted_cash":1486.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.2 G"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO [81453]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0186-0372-28","type":"NDC"}],"standard_charges":[{"gross_charge":360.72,"discounted_cash":360.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.9 G"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1412-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0409-1412-40","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6007-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6007-10","type":"NDC"}],"standard_charges":[{"gross_charge":43.3,"discounted_cash":43.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6008-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"0641-6008-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-570-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-570-04","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP [28774]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"69097-318-32","type":"NDC"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 MG"}]},{"description":"BUDESON-GLYCOPYRROL-FORMOTEROL 160-9-4.8 MCG/ACT IN AERO [143622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-4616-39","type":"NDC"}],"standard_charges":[{"gross_charge":1436.5,"discounted_cash":1436.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.9 G"}]},{"description":"BUDESON-GLYCOPYRROL-FORMOTEROL 160-9-4.8 MCG/ACT IN AERO [143622]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0310-4616-12","type":"NDC"}],"standard_charges":[{"gross_charge":3743.76,"discounted_cash":3743.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.7 G"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN [31158]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-144-05","type":"NDC"}],"standard_charges":[{"gross_charge":413.7,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"24208-411-15","type":"NDC"}],"standard_charges":[{"gross_charge":261.27,"discounted_cash":261.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-143-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.84,"discounted_cash":24.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"61314-143-15","type":"NDC"}],"standard_charges":[{"gross_charge":30.87,"discounted_cash":30.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"70069-231-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN [17881]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"71921-185-05","type":"NDC"}],"standard_charges":[{"gross_charge":64.2,"discounted_cash":64.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRINZOLAMIDE 1 % OP SUSP [22953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-6014-70","type":"NDC"}],"standard_charges":[{"gross_charge":1411.14,"discounted_cash":1411.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRINZOLAMIDE 1 % OP SUSP [22953]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"68682-464-10","type":"NDC"}],"standard_charges":[{"gross_charge":561.78,"discounted_cash":561.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BRIVARACETAM 10 MG/ML PO SOLN [131137]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50474-870-15","type":"NDC"}],"standard_charges":[{"gross_charge":4034.1,"discounted_cash":4034.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"BRIVARACETAM 25 MG PO TABS [131133]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50474-470-66","type":"NDC"}],"standard_charges":[{"gross_charge":67.25,"discounted_cash":67.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 EACH"}]},{"description":"BRIVARACETAM 50 MG/5ML IV SOLN [131138]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"50474-970-75","type":"NDC"}],"standard_charges":[{"gross_charge":2693.16,"discounted_cash":2693.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BROMOCRIPTINE MESYLATE 2.5 MG PO TABS [9297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0574-0106-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"BROMOCRIPTINE MESYLATE 2.5 MG PO TABS [9297]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0781-5325-31","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 MG"}]},{"description":"BROMPHENIRAMINE-PHENYLEPHRINE 1-2.5 MG/5ML PO ELIX [77434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0031-2235-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BSS PLUS IO SOLN [834]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0800-94","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":12.42,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"},{"gross_charge":414.0,"discounted_cash":414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"BSS IO SOLN [37579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-1795-04","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"BSS IO SOLN [37579]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"0065-0795-15","type":"NDC"}],"standard_charges":[{"gross_charge":36.99,"discounted_cash":36.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"65219-572-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BROMPHENIRAMINE-PHENYLEPHRINE 2-5 MG/10ML PO LIQD [135539]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"50026-66002","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BROMPHENIRAMINE-PHENYLEPHRINE 1-2.5 MG/5ML PO ELIX [77434]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0485-0202-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"},{"gross_charge":1.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"70860-406-41","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN [9308]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"72205-102-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 1 MG PO TABS [9310]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"637","type":"RC"},{"code":"0185-0129-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 MG"},{"gross_charge":12.25,"discounted_cash":12.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 MG"},{"gross_charge":24.5,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 MG"},{"gross_charge":49.0,"discounted_cash":49.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0143-9331-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0143-9334-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-1162-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-1162-18","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-1560-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":49.18,"discounted_cash":49.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"0409-1560-18","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":47.92,"discounted_cash":47.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN [105640]","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323-466-03","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 MG"},{"gross_charge":42.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"},{"gross_charge":45.46,"discounted_cash":45.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 MG"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":590.48,"10th_percentile":590.48,"90th_percentile":2306.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26599.14,"10th_percentile":22785.98,"90th_percentile":50723.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":20073.89,"10th_percentile":20073.89,"90th_percentile":20073.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9529.47,"10th_percentile":9529.47,"90th_percentile":9529.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":35763.62,"10th_percentile":33418.93,"90th_percentile":43233.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14070.57,"10th_percentile":14070.57,"90th_percentile":14114.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38662.49,"10th_percentile":38662.49,"90th_percentile":38662.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9263.52,"10th_percentile":9263.52,"90th_percentile":9813.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11697.13,"10th_percentile":11697.13,"90th_percentile":11697.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":28322.27,"10th_percentile":28322.27,"90th_percentile":28322.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8169.93,"10th_percentile":7916.08,"90th_percentile":10699.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7899.78,"maximum":37611.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8452.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8452.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18959.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15513.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7899.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32164.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15253.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37611.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27286.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8373.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18722.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7899.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8452.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7899.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9479.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23721.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18959.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8294.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24225.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8452.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14380.33,"maximum":56188.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15099.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15386.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15386.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34512.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20195.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14380.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41871.53},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17917.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48962.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56188.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15243.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34081.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17256.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14380.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15386.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14380.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17256.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48848.71},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34512.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15099.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49885.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15386.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11441.45,"10th_percentile":6081.95,"90th_percentile":13823.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":24628.26,"10th_percentile":24628.26,"90th_percentile":24628.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13735.59,"10th_percentile":11936.86,"90th_percentile":16843.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35364.58,"10th_percentile":33164.52,"90th_percentile":95775.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19615.8,"10th_percentile":14603.89,"90th_percentile":26232.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13250.8,"10th_percentile":12143.38,"90th_percentile":13824.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":42978.11,"10th_percentile":41447.65,"90th_percentile":86008.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":18069.46,"10th_percentile":16873.65,"90th_percentile":22346.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":47116.97,"10th_percentile":47116.97,"90th_percentile":47116.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"42","median_amount":12683.54,"10th_percentile":787.08,"90th_percentile":15450.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28636.97,"10th_percentile":28636.97,"90th_percentile":28636.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10989.23,"10th_percentile":10989.23,"90th_percentile":10989.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14211.92,"10th_percentile":13608.34,"90th_percentile":14878.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13262.45,"10th_percentile":13262.45,"90th_percentile":13262.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15707.38,"10th_percentile":15707.38,"90th_percentile":15707.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10990.94,"10th_percentile":10990.94,"90th_percentile":10990.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":26175.49,"10th_percentile":26175.49,"90th_percentile":48120.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33775.72,"10th_percentile":33775.72,"90th_percentile":33775.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"45","median_amount":13106.02,"10th_percentile":1145.08,"90th_percentile":13996.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":52196.81,"10th_percentile":52196.81,"90th_percentile":52196.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12653.58,"10th_percentile":12653.58,"90th_percentile":14343.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8304.23,"maximum":37343.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8719.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15403.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31935.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11828.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37343.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30469.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8802.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19681.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8304.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8304.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9965.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26489.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8719.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27051.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7974.07,"10th_percentile":6903.85,"90th_percentile":8811.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":14907.62,"10th_percentile":14007.28,"90th_percentile":29757.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7732.6,"10th_percentile":646.49,"90th_percentile":9606.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19106.09,"10th_percentile":11233.75,"90th_percentile":21612.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15163.02,"10th_percentile":8191.63,"90th_percentile":23154.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7827.78,"10th_percentile":6320.42,"90th_percentile":8148.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"29","median_amount":30153.35,"10th_percentile":19960.37,"90th_percentile":34941.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11036.5,"10th_percentile":10014.61,"90th_percentile":12976.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":38285.95,"10th_percentile":38285.95,"90th_percentile":38285.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9577.04,"10th_percentile":9577.04,"90th_percentile":9577.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30383.05,"10th_percentile":1426.42,"90th_percentile":32613.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"31","median_amount":7332.64,"10th_percentile":654.49,"90th_percentile":8529.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14743.53,"10th_percentile":576.93,"90th_percentile":15933.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10637.41,"10th_percentile":10637.41,"90th_percentile":10637.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8146.98,"10th_percentile":8000.86,"90th_percentile":8936.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2316.59,"10th_percentile":2316.59,"90th_percentile":2316.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9196.16,"10th_percentile":9196.16,"90th_percentile":9198.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6958.58,"10th_percentile":6958.58,"90th_percentile":7006.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":25693.43,"10th_percentile":4567.33,"90th_percentile":27418.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"52","median_amount":7281.11,"10th_percentile":694.26,"90th_percentile":8260.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":27224.6,"10th_percentile":27224.6,"90th_percentile":27224.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7939.68,"10th_percentile":7939.68,"90th_percentile":8464.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5792.18,"maximum":31047.28,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13901.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12805.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5792.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26550.69},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8692.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31047.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19674.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6139.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13727.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5792.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5792.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6950.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17104.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13901.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6081.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17467.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13148.89,"10th_percentile":13148.89,"90th_percentile":13148.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10868.52,"10th_percentile":10868.52,"90th_percentile":10868.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13243.9,"10th_percentile":13243.9,"90th_percentile":13243.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":14634.61,"10th_percentile":7400.41,"90th_percentile":23244.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":6156.92,"10th_percentile":6156.92,"90th_percentile":6156.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8755.55,"10th_percentile":8755.55,"90th_percentile":8755.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6491.21,"10th_percentile":6491.21,"90th_percentile":6491.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":715.8,"10th_percentile":715.8,"90th_percentile":715.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15342.69,"maximum":59470.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36822.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21656.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44900.61},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19311.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52504.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59470.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16263.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36362.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18411.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15342.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15342.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18411.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51702.09},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36822.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16109.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52798.94},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16416.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9203.17,"10th_percentile":9203.17,"90th_percentile":14322.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34683.31,"10th_percentile":971.07,"90th_percentile":47716.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14466.01,"10th_percentile":14466.01,"90th_percentile":14466.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":41865.0,"10th_percentile":36669.19,"90th_percentile":45904.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17714.84,"10th_percentile":17714.84,"90th_percentile":17714.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16022.45,"10th_percentile":16022.45,"90th_percentile":16022.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32619.62,"10th_percentile":32619.62,"90th_percentile":32619.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16380.09,"10th_percentile":16380.09,"90th_percentile":16380.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15431.92,"10th_percentile":15431.92,"90th_percentile":16024.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13208.65,"10th_percentile":13208.65,"90th_percentile":13208.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9041.42,"maximum":41398.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9493.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21699.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17075.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9041.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35403.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10734.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41398.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33658.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9583.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21428.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9041.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9041.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29261.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21699.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9493.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29882.73},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9674.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8819.97,"10th_percentile":8804.45,"90th_percentile":8820.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9182.33,"10th_percentile":9182.33,"90th_percentile":9182.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20539.63,"10th_percentile":13426.95,"90th_percentile":21342.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9760.2,"10th_percentile":9760.2,"90th_percentile":9760.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23679.9,"10th_percentile":17991.51,"90th_percentile":34266.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10934.79,"10th_percentile":9136.45,"90th_percentile":12151.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34074.8,"10th_percentile":34074.8,"90th_percentile":34074.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8227.19,"10th_percentile":8227.19,"90th_percentile":8227.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9381.49,"10th_percentile":9381.49,"90th_percentile":9381.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8729.45,"10th_percentile":8729.45,"90th_percentile":8729.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8883.9,"10th_percentile":8883.9,"90th_percentile":9519.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7012.71,"maximum":35391.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16830.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14597.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7012.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30265.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10691.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35391.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23157.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7433.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16620.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7012.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7012.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20132.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16830.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7363.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20559.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7503.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13662.4,"10th_percentile":13662.4,"90th_percentile":13662.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30464.01,"10th_percentile":23160.05,"90th_percentile":40493.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9143.88,"10th_percentile":9143.88,"90th_percentile":9143.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11172.68,"maximum":40380.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11954.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11954.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26814.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16655.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11172.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34532.18},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24148.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40380.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39070.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11843.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26479.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11172.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11954.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11172.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33966.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26814.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11731.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34687.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11954.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17453.17,"10th_percentile":17453.17,"90th_percentile":17453.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7401.38,"maximum":30765.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17763.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12689.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26309.49},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10238.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30765.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26874.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7845.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17541.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8881.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7401.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7401.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8881.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23364.41},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17763.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23860.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7919.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17105.14,"10th_percentile":17105.14,"90th_percentile":17105.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23230.96,"10th_percentile":23230.96,"90th_percentile":23230.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7385.99,"10th_percentile":7385.99,"90th_percentile":7385.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12252.85,"maximum":50211.35,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30284.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22565.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12618.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32126.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12252.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37567.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50211.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13375.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29905.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15142.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12618.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12618.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15142.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43652.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30284.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44578.52},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13501.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12224.75,"10th_percentile":12224.75,"90th_percentile":12224.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":13506.87,"10th_percentile":13506.87,"90th_percentile":13506.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":794.38,"10th_percentile":794.38,"90th_percentile":794.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22920.36,"10th_percentile":22920.36,"90th_percentile":22920.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":32121.89,"10th_percentile":32121.89,"90th_percentile":32121.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":714.12,"10th_percentile":714.12,"90th_percentile":714.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":32835.56,"10th_percentile":32542.56,"90th_percentile":32950.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":34149.84,"10th_percentile":34149.84,"90th_percentile":34149.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":732.0,"10th_percentile":732.0,"90th_percentile":732.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10207.48,"10th_percentile":10207.48,"90th_percentile":10207.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11272.46,"10th_percentile":11272.46,"90th_percentile":11272.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8272.68,"maximum":31713.94,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8686.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19854.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16265.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27120.8},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11279.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31713.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30670.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8769.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19606.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8272.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8272.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9927.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26663.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19854.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8686.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27229.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8851.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":27019.58,"10th_percentile":27019.58,"90th_percentile":27019.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19036.5,"10th_percentile":18731.74,"90th_percentile":19461.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16462.56,"10th_percentile":15048.27,"90th_percentile":24774.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":28701.34,"10th_percentile":18978.57,"90th_percentile":43889.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10050.74,"10th_percentile":9794.86,"90th_percentile":11499.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":25336.02,"10th_percentile":25336.02,"90th_percentile":25336.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22593.06,"10th_percentile":22593.06,"90th_percentile":22593.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6194.64,"10th_percentile":6194.64,"90th_percentile":6194.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7881.15,"10th_percentile":7881.15,"90th_percentile":7881.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":28212.4,"10th_percentile":28212.4,"90th_percentile":28212.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7397.4,"10th_percentile":7397.4,"90th_percentile":7397.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6157.19,"maximum":20715.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6588.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6588.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14777.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14334.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14299.66},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8438.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16721.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20715.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14592.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6588.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6157.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18009.62},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14777.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18391.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6588.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5038.67,"10th_percentile":5038.67,"90th_percentile":5038.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":3216.54,"10th_percentile":3216.54,"90th_percentile":3216.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5001.56,"10th_percentile":5001.56,"90th_percentile":5001.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5101.68,"10th_percentile":5101.68,"90th_percentile":5101.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":16123.61,"10th_percentile":14890.44,"90th_percentile":28102.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":7408.88,"10th_percentile":7408.88,"90th_percentile":7945.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20404.95,"10th_percentile":20404.95,"90th_percentile":20404.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5784.23,"10th_percentile":5784.23,"90th_percentile":5784.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14848.09,"10th_percentile":14848.09,"90th_percentile":14848.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5802.88,"10th_percentile":5802.88,"90th_percentile":5802.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":16703.81,"10th_percentile":16703.81,"90th_percentile":16703.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5717.49,"10th_percentile":5717.49,"90th_percentile":5717.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":24953.82,"10th_percentile":24953.82,"90th_percentile":24953.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11861.83,"maximum":47105.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28468.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19429.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11861.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40283.37},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13592.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47105.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45430.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28112.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14234.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11861.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11861.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14234.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39495.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28468.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40333.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10490.71,"10th_percentile":10490.71,"90th_percentile":10490.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12786.45,"10th_percentile":12786.45,"90th_percentile":12786.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16832.0,"10th_percentile":16832.0,"90th_percentile":16832.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9915.7,"10th_percentile":9915.7,"90th_percentile":9915.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":40257.76,"10th_percentile":34108.27,"90th_percentile":60322.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13792.14,"10th_percentile":13792.14,"90th_percentile":13792.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10423.89,"10th_percentile":9300.98,"90th_percentile":10428.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19694.77,"10th_percentile":19694.77,"90th_percentile":19694.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12065.48,"10th_percentile":12065.48,"90th_percentile":12065.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":33018.82,"10th_percentile":33018.82,"90th_percentile":33018.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10002.37,"10th_percentile":9835.14,"90th_percentile":12186.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":521.97,"10th_percentile":521.97,"90th_percentile":521.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6935.26,"maximum":24776.54,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7282.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16644.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14402.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6935.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20902.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9319.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24442.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24776.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16436.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6935.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6935.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8322.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21540.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16644.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7282.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21997.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7420.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5914.72,"10th_percentile":5914.72,"90th_percentile":5914.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":19112.16,"10th_percentile":15945.21,"90th_percentile":68744.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6826.91,"10th_percentile":311.45,"90th_percentile":7577.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17361.7,"10th_percentile":17361.7,"90th_percentile":17361.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":14402.88,"10th_percentile":14035.63,"90th_percentile":14654.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6466.07,"10th_percentile":6193.76,"90th_percentile":7109.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20500.5,"10th_percentile":18963.36,"90th_percentile":21318.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9519.02,"10th_percentile":9519.02,"90th_percentile":26033.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5799.09,"10th_percentile":5799.09,"90th_percentile":5799.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20397.16,"10th_percentile":20397.16,"90th_percentile":20397.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5867.5,"10th_percentile":368.56,"90th_percentile":6723.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13223.64,"10th_percentile":13223.64,"90th_percentile":13393.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6794.38,"10th_percentile":6794.38,"90th_percentile":7753.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7608.2,"10th_percentile":7608.2,"90th_percentile":7608.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6308.15,"10th_percentile":6308.15,"90th_percentile":6308.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":12020.63,"10th_percentile":12020.63,"90th_percentile":12020.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6591.86,"10th_percentile":4822.96,"90th_percentile":6666.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":23081.94,"10th_percentile":23081.94,"90th_percentile":23081.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5172.6,"maximum":16908.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12414.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10968.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5172.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13644.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6963.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15955.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16908.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5482.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12259.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5172.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5172.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6207.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14699.48},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12414.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15011.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5534.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5120.37,"10th_percentile":4837.74,"90th_percentile":5477.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":12424.79,"10th_percentile":11773.83,"90th_percentile":16187.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4937.78,"10th_percentile":267.21,"90th_percentile":6799.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8116.99,"10th_percentile":8116.99,"90th_percentile":11996.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":7838.11,"10th_percentile":5507.86,"90th_percentile":11165.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5378.92,"10th_percentile":5378.92,"90th_percentile":5378.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"19","median_amount":13521.75,"10th_percentile":9579.42,"90th_percentile":16915.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5855.45,"10th_percentile":5770.92,"90th_percentile":6963.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4538.8,"10th_percentile":4538.8,"90th_percentile":4538.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17600.74,"10th_percentile":17600.74,"90th_percentile":17600.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4102.71,"10th_percentile":308.5,"90th_percentile":4954.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8191.69,"10th_percentile":8191.69,"90th_percentile":8191.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5077.17,"10th_percentile":5077.17,"90th_percentile":6488.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5559.86,"10th_percentile":5559.86,"90th_percentile":5559.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":11018.33,"10th_percentile":11018.33,"90th_percentile":11018.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4900.49,"10th_percentile":4900.49,"90th_percentile":4900.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":3962.04,"10th_percentile":3962.04,"90th_percentile":3962.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4721.42,"10th_percentile":4721.42,"90th_percentile":4721.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10366.65,"maximum":39709.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10884.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24879.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14451.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29961.93},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13402.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35036.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39709.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10988.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24568.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10366.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10366.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12439.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34522.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24879.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10884.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35255.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10063.4,"10th_percentile":9936.49,"90th_percentile":12910.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11024.11,"10th_percentile":11024.11,"90th_percentile":11024.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9923.34,"10th_percentile":9923.34,"90th_percentile":13187.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15163.7,"10th_percentile":15163.7,"90th_percentile":15163.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11603.03,"10th_percentile":11603.03,"90th_percentile":21801.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9654.6,"10th_percentile":9647.52,"90th_percentile":9682.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30378.03,"10th_percentile":12155.26,"90th_percentile":57187.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14079.17,"10th_percentile":11850.58,"90th_percentile":14513.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":8610.87,"10th_percentile":486.94,"90th_percentile":10878.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21029.67,"10th_percentile":21029.67,"90th_percentile":21204.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10503.13,"10th_percentile":10479.92,"90th_percentile":11118.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":7678.39,"10th_percentile":7678.39,"90th_percentile":7678.39},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7256.42,"10th_percentile":7256.42,"90th_percentile":7256.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":3924.13,"10th_percentile":3924.13,"90th_percentile":3924.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":9973.94,"10th_percentile":7981.49,"90th_percentile":10921.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":53517.3,"10th_percentile":53517.3,"90th_percentile":53517.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1204.57,"10th_percentile":1204.57,"90th_percentile":1204.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6862.11,"maximum":26083.97,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16469.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10758.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22306.21},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8687.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26083.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24115.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7273.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16263.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6862.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6862.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8234.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20965.1},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16469.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7205.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21409.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6172.5,"10th_percentile":5443.49,"90th_percentile":6613.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5587.4,"10th_percentile":2035.35,"90th_percentile":10698.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":6362.13,"10th_percentile":6362.13,"90th_percentile":21607.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6630.24,"10th_percentile":400.08,"90th_percentile":7410.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":10273.72,"10th_percentile":221.54,"90th_percentile":15156.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"17","median_amount":6453.55,"10th_percentile":2538.29,"90th_percentile":13836.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6106.52,"10th_percentile":937.09,"90th_percentile":6872.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":18686.8,"10th_percentile":18686.8,"90th_percentile":18686.8},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"39","median_amount":19358.46,"10th_percentile":5738.09,"90th_percentile":29263.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"22","median_amount":8524.23,"10th_percentile":7109.53,"90th_percentile":9311.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":17052.34,"10th_percentile":11888.56,"90th_percentile":24563.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4746.23,"10th_percentile":4746.23,"90th_percentile":4746.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24207.23,"10th_percentile":19100.8,"90th_percentile":24804.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":2537.34,"10th_percentile":363.34,"90th_percentile":7214.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10916.63,"10th_percentile":10526.74,"90th_percentile":13056.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4842.78,"10th_percentile":4842.78,"90th_percentile":11130.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6862.43,"10th_percentile":6507.28,"90th_percentile":7395.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":352.97,"10th_percentile":352.97,"90th_percentile":352.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7410.81,"10th_percentile":7410.81,"90th_percentile":7410.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5243.34,"10th_percentile":5243.34,"90th_percentile":8870.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"12","median_amount":20436.45,"10th_percentile":17180.64,"90th_percentile":21685.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":6312.56,"10th_percentile":511.81,"90th_percentile":7007.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":10346.46,"10th_percentile":10346.46,"90th_percentile":18348.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7405.38,"10th_percentile":7405.38,"90th_percentile":7405.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12740.29,"maximum":51175.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30576.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19999.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41464.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14531.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48486.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51175.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13504.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30194.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15288.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12740.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15288.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44490.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30576.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13377.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45434.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13632.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12255.89,"10th_percentile":12255.89,"90th_percentile":12985.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":28307.22,"10th_percentile":28307.22,"90th_percentile":38664.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13100.43,"10th_percentile":11751.49,"90th_percentile":23475.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12025.56,"10th_percentile":1488.84,"90th_percentile":12319.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":42056.16,"10th_percentile":23343.18,"90th_percentile":49072.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14140.87,"10th_percentile":12622.35,"90th_percentile":14731.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21123.28,"10th_percentile":21123.28,"90th_percentile":21123.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":11047.44,"10th_percentile":900.16,"90th_percentile":13423.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24542.36,"10th_percentile":24542.36,"90th_percentile":24542.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13003.21,"10th_percentile":13003.21,"90th_percentile":13322.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":11396.84,"10th_percentile":10697.52,"90th_percentile":12489.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12419.24,"10th_percentile":12419.24,"90th_percentile":12419.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7981.53,"maximum":29090.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8380.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8540.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8540.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19155.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15496.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7981.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19277.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11864.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22541.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29090.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18916.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7981.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8540.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7981.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25290.85},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19155.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8380.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25827.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8540.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7584.31,"10th_percentile":6977.1,"90th_percentile":8309.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":33637.22,"10th_percentile":33637.22,"90th_percentile":33637.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":335.74,"10th_percentile":285.44,"90th_percentile":402.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11912.99,"10th_percentile":11746.84,"90th_percentile":18051.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15482.94,"10th_percentile":13733.42,"90th_percentile":18342.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9741.43,"10th_percentile":9741.43,"90th_percentile":9741.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":19693.23,"10th_percentile":16566.65,"90th_percentile":29528.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11582.5,"10th_percentile":9904.62,"90th_percentile":12064.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":22498.34,"10th_percentile":22498.34,"90th_percentile":22498.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13258.66,"10th_percentile":13258.66,"90th_percentile":13258.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6639.06,"10th_percentile":1936.38,"90th_percentile":7732.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":21173.81,"10th_percentile":21173.81,"90th_percentile":21173.81},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15018.62,"10th_percentile":15018.62,"90th_percentile":15018.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9533.54,"10th_percentile":9533.54,"90th_percentile":9533.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7479.92,"10th_percentile":7479.92,"90th_percentile":7479.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8835.82,"10th_percentile":8835.82,"90th_percentile":8835.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":27807.59,"10th_percentile":27807.59,"90th_percentile":27807.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6901.48,"10th_percentile":6468.54,"90th_percentile":8592.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":365.35,"10th_percentile":365.35,"90th_percentile":365.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5925.56,"maximum":19667.94,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6221.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6340.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6340.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14221.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11896.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5925.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14290.26},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8554.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16710.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19667.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6281.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14043.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7110.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5925.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6340.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5925.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7110.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17098.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14221.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6221.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17461.54},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6340.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":15791.63,"10th_percentile":15791.63,"90th_percentile":15791.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":14290.26,"10th_percentile":13235.76,"90th_percentile":21927.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8754.69,"10th_percentile":8754.69,"90th_percentile":9225.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":5736.44,"10th_percentile":5736.44,"90th_percentile":5736.44},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4019.73,"10th_percentile":4019.73,"90th_percentile":4019.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10149.12,"10th_percentile":10149.12,"90th_percentile":10149.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6361.54,"10th_percentile":6361.54,"90th_percentile":6361.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5456.42,"10th_percentile":5456.42,"90th_percentile":5456.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":1276.28,"10th_percentile":1276.28,"90th_percentile":1276.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":168.89,"10th_percentile":168.89,"90th_percentile":168.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18445.64,"maximum":85317.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19367.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19736.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19736.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35190.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72961.14},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29256.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85317.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76570.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43716.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22134.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18445.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19736.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18445.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22134.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":66568.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44269.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19367.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67980.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19736.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3101.63,"10th_percentile":3101.63,"90th_percentile":3101.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":60594.15,"10th_percentile":60594.15,"90th_percentile":60594.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78355.09,"10th_percentile":78355.09,"90th_percentile":78355.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":68285.58,"10th_percentile":68285.58,"90th_percentile":68285.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12125.72,"maximum":47146.01,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12974.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12974.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29101.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25670.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12125.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40317.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22370.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47146.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46768.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12853.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28737.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12125.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12974.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12125.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14550.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40659.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29101.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12732.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41521.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12974.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":504.58,"10th_percentile":504.58,"90th_percentile":504.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24196.78,"10th_percentile":24196.78,"90th_percentile":27457.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10667.92,"10th_percentile":10667.92,"90th_percentile":10667.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":39661.66,"10th_percentile":39661.66,"90th_percentile":39661.66},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":39907.44,"10th_percentile":39907.44,"90th_percentile":40069.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21117.67,"10th_percentile":19949.83,"90th_percentile":23891.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11449.65,"10th_percentile":11449.65,"90th_percentile":11449.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11946.17,"10th_percentile":11946.17,"90th_percentile":11946.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12286.07,"10th_percentile":12286.07,"90th_percentile":12286.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9480.29,"maximum":34740.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9954.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22752.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17271.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9480.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29044.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19895.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33963.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34740.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10049.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22468.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9480.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9480.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11376.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30202.32},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22752.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9954.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30843.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10143.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":814.67,"10th_percentile":814.67,"90th_percentile":814.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16277.39,"10th_percentile":16277.39,"90th_percentile":16879.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8051.4,"10th_percentile":8051.4,"90th_percentile":8051.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30581.85,"10th_percentile":30394.97,"90th_percentile":43191.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":18549.96,"10th_percentile":17798.34,"90th_percentile":20843.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10325.31,"10th_percentile":10325.31,"90th_percentile":10325.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11308.96,"10th_percentile":11308.96,"90th_percentile":11308.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":30271.72,"10th_percentile":30271.72,"90th_percentile":33543.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":26342.7,"10th_percentile":26342.7,"90th_percentile":26342.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8664.59,"10th_percentile":8664.59,"90th_percentile":8664.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30103.03,"maximum":121431.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31608.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":72247.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":90576.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96388.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70619.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112713.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121431.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31909.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":71344.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":30103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":105569.75},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":72247.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31608.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":107809.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32210.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31353.57,"10th_percentile":31353.57,"90th_percentile":31353.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":95852.45,"10th_percentile":95852.45,"90th_percentile":95852.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30281.24,"10th_percentile":30281.24,"90th_percentile":30281.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":88784.66,"10th_percentile":86088.69,"90th_percentile":91386.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27724.37,"10th_percentile":27724.37,"90th_percentile":30175.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":106547.89,"10th_percentile":100298.02,"90th_percentile":121337.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":72277.63,"10th_percentile":72277.63,"90th_percentile":72296.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":31776.57,"10th_percentile":31776.57,"90th_percentile":32862.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29223.48,"10th_percentile":28817.88,"90th_percentile":31925.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28652.96,"10th_percentile":28652.96,"90th_percentile":28652.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29871.0,"10th_percentile":29871.0,"90th_percentile":29871.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":111157.6,"10th_percentile":107966.33,"90th_percentile":124458.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40501.17,"maximum":176822.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee 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schedule","standard_charge_dollar":151213.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73352.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176822.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167764.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42931.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":95987.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48601.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":40501.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43336.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40501.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48601.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":145850.25},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97202.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42526.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":148944.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43336.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40904.23,"10th_percentile":40904.23,"90th_percentile":40904.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":52369.88,"10th_percentile":52369.88,"90th_percentile":52369.88},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":216251.39,"10th_percentile":216251.39,"90th_percentile":216251.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":75935.62,"10th_percentile":75935.62,"90th_percentile":75935.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":54704.89,"10th_percentile":54704.89,"90th_percentile":54704.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32202.53,"10th_percentile":32202.53,"90th_percentile":37522.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36875.06,"10th_percentile":36875.06,"90th_percentile":36875.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":149231.93,"10th_percentile":149231.93,"90th_percentile":149231.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35319.43,"10th_percentile":35319.43,"90th_percentile":35319.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22069.21,"maximum":121423.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23172.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23614.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23614.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50082.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22069.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103837.75},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41756.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121423.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86787.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23393.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52304.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26483.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22069.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23614.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22069.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26483.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":75450.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23172.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":77051.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23614.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20555.35,"10th_percentile":20555.35,"90th_percentile":21135.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":106721.66,"10th_percentile":102791.31,"90th_percentile":111524.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":44107.02,"10th_percentile":44046.56,"90th_percentile":44757.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23513.08,"10th_percentile":23513.08,"90th_percentile":23513.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20117.05,"10th_percentile":20117.05,"90th_percentile":20117.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17188.54,"maximum":82207.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18047.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18391.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18391.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41252.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33907.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17188.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70301.69},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31353.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82207.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66000.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18219.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40736.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17188.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18391.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17188.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20626.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57379.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41252.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18047.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58596.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18391.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16379.02,"10th_percentile":16379.02,"90th_percentile":16575.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":125433.61,"10th_percentile":125433.61,"90th_percentile":125433.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38773.1,"10th_percentile":38773.1,"90th_percentile":38773.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":72157.12,"10th_percentile":72157.12,"90th_percentile":72157.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18801.31,"10th_percentile":18801.31,"90th_percentile":18801.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16937.32,"10th_percentile":16937.32,"90th_percentile":16937.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16593.36,"10th_percentile":16593.36,"90th_percentile":16593.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26840.88,"maximum":141170.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28182.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28719.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28719.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58227.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26840.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120724.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64074.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141170.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108201.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28451.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63612.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32209.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26840.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28719.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26840.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32209.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":94067.55},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28182.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96063.18},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28719.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60963.73,"10th_percentile":60963.73,"90th_percentile":60963.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":59391.31,"10th_percentile":59391.31,"90th_percentile":59391.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16885.2,"maximum":106687.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17729.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40524.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44004.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16885.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91235.88},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33774.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106687.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64786.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17898.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40017.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20262.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16885.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16885.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20262.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56323.39},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40524.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17729.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57518.28},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":91083.69,"10th_percentile":91083.69,"90th_percentile":91083.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":46526.13,"10th_percentile":46526.13,"90th_percentile":46526.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15967.38,"10th_percentile":15967.38,"90th_percentile":15967.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12657.1,"maximum":76167.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30377.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31416.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65136.27},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26739.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76167.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47933.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29997.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15188.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15188.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41672.27},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30377.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13289.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42556.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13543.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":67725.89,"10th_percentile":67725.89,"90th_percentile":67725.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23047.55,"10th_percentile":23047.55,"90th_percentile":23047.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24959.9,"maximum":125009.64,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26207.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26707.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26707.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59903.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51562.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24959.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106904.42},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50283.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125009.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84568.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26457.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59154.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29951.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24959.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26707.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24959.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29951.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":73521.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59903.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26207.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":75081.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26707.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16348.8,"maximum":96636.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17166.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17493.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17493.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39237.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39859.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16348.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82640.43},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34966.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96636.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65874.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17329.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38746.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19618.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16348.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17493.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16348.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19618.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57269.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39237.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17166.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58484.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17493.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38812.72,"10th_percentile":38812.72,"90th_percentile":38812.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16608.4,"maximum":65255.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17438.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39860.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26030.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53969.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20129.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63109.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65255.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17604.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39361.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19930.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16608.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16608.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19930.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56731.78},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39860.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17438.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57935.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17770.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14549.82,"10th_percentile":14549.82,"90th_percentile":14549.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":2011.02,"10th_percentile":2011.02,"90th_percentile":2011.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16082.1,"10th_percentile":16082.1,"90th_percentile":16082.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37262.55,"10th_percentile":37262.55,"90th_percentile":37262.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":26607.49,"10th_percentile":26607.49,"90th_percentile":26607.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15995.41,"10th_percentile":15995.41,"90th_percentile":15995.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":52955.43,"10th_percentile":37904.44,"90th_percentile":116967.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":20748.47,"10th_percentile":20748.47,"90th_percentile":21352.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":42282.83,"10th_percentile":42282.83,"90th_percentile":42282.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":66660.1,"10th_percentile":66660.1,"90th_percentile":66660.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14580.62,"10th_percentile":13998.29,"90th_percentile":18486.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15994.03,"10th_percentile":15994.03,"90th_percentile":15994.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18095.14,"10th_percentile":18095.14,"90th_percentile":18095.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16163.05,"10th_percentile":16163.05,"90th_percentile":16163.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6487.78,"maximum":22415.4,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15570.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9065.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18794.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7819.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21977.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22415.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15376.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6487.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6487.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7785.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19487.36},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15570.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6812.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19900.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6941.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5913.15,"10th_percentile":5913.15,"90th_percentile":5913.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14656.47,"10th_percentile":14656.47,"90th_percentile":14656.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5951.43,"10th_percentile":5951.43,"90th_percentile":5951.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":17594.73,"10th_percentile":10330.75,"90th_percentile":19210.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5998.29,"10th_percentile":5998.29,"90th_percentile":5998.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7720.18,"10th_percentile":7720.18,"90th_percentile":7720.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11543.74,"10th_percentile":11543.74,"90th_percentile":11543.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6040.42,"10th_percentile":6040.42,"90th_percentile":6040.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7432.3,"10th_percentile":7432.3,"90th_percentile":7432.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":1291.7,"10th_percentile":1291.7,"90th_percentile":1291.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8593.22,"maximum":31810.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9194.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9194.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9820.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20360.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10545.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23809.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31810.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9108.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20365.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10311.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8593.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9194.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8593.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10311.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27655.23},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20623.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9022.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28241.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9194.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10035.85,"10th_percentile":10035.85,"90th_percentile":10035.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8474.59,"10th_percentile":6623.37,"90th_percentile":9217.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10027.37,"10th_percentile":9512.97,"90th_percentile":12171.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8177.83,"10th_percentile":8177.83,"90th_percentile":8770.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20639.03,"10th_percentile":14780.87,"90th_percentile":21219.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9744.28,"10th_percentile":8436.6,"90th_percentile":18771.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31814.86,"10th_percentile":31814.86,"90th_percentile":31814.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5968.44,"10th_percentile":534.38,"90th_percentile":7636.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15704.29,"10th_percentile":15704.29,"90th_percentile":15704.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8486.89,"10th_percentile":8486.89,"90th_percentile":8486.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9462.45,"10th_percentile":9462.45,"90th_percentile":9462.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10506.26,"10th_percentile":10506.26,"90th_percentile":10506.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":21913.22,"10th_percentile":21913.22,"90th_percentile":26498.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7827.44,"10th_percentile":7827.44,"90th_percentile":8107.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9184.18,"10th_percentile":9184.18,"90th_percentile":9184.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12086.75,"maximum":54031.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14685.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33567.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12086.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25059.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14854.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29303.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54031.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14825.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33148.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13986.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13986.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16783.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46973.32},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33567.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14685.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47969.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14965.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13180.6,"10th_percentile":13180.6,"90th_percentile":13180.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31482.0,"10th_percentile":31482.0,"90th_percentile":31482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13851.74,"10th_percentile":12283.56,"90th_percentile":33941.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12111.29,"10th_percentile":12111.29,"90th_percentile":12111.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":28995.28,"10th_percentile":25658.98,"90th_percentile":58981.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12897.49,"10th_percentile":12897.49,"90th_percentile":12897.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1378.56,"10th_percentile":1378.56,"90th_percentile":1378.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10559.11,"10th_percentile":10559.11,"90th_percentile":10559.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12394.51,"10th_percentile":517.31,"90th_percentile":18271.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29359.8,"10th_percentile":29359.8,"90th_percentile":29359.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":22401.57,"10th_percentile":22401.57,"90th_percentile":22401.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10995.0,"10th_percentile":6453.08,"90th_percentile":13221.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17606.95,"10th_percentile":17606.95,"90th_percentile":17606.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12590.73,"10th_percentile":12590.73,"90th_percentile":13590.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6297.03,"maximum":35010.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15112.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14440.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29940.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11626.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35010.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21568.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6674.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14923.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6297.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6297.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7556.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18751.18},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15112.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19148.98},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10351.96,"10th_percentile":10351.96,"90th_percentile":10351.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8444.07,"maximum":39702.87,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8866.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16376.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8444.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33952.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10038.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39702.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31448.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8950.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20012.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10132.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8444.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8444.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10132.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27340.88},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20265.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8866.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27920.91},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9035.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8449.93,"10th_percentile":8449.93,"90th_percentile":8449.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16511.72,"10th_percentile":16511.72,"90th_percentile":16511.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8102.53,"10th_percentile":8102.53,"90th_percentile":8102.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":33842.92,"10th_percentile":33842.92,"90th_percentile":33842.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10478.23,"10th_percentile":10478.23,"90th_percentile":10478.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":617.25,"10th_percentile":617.25,"90th_percentile":617.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8225.7,"10th_percentile":8225.7,"90th_percentile":8225.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9434.05,"10th_percentile":9434.05,"90th_percentile":9434.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8285.86,"10th_percentile":7017.91,"90th_percentile":9077.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12687.22,"maximum":51608.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30449.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20831.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43190.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19431.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50504.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51608.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13448.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30068.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15224.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12687.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12687.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15224.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44866.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30449.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13321.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45818.72},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13575.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":499.19,"10th_percentile":499.19,"90th_percentile":499.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":35747.09,"10th_percentile":35747.09,"90th_percentile":35747.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10752.42,"10th_percentile":10752.42,"90th_percentile":10953.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":375.4,"10th_percentile":375.4,"90th_percentile":375.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12855.12,"10th_percentile":12855.12,"90th_percentile":12855.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":977.59,"10th_percentile":977.59,"90th_percentile":12084.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11296.02,"maximum":63490.16,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11860.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12086.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12086.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27110.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26187.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11296.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54294.84},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22926.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63490.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41876.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11973.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26771.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13555.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11296.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12086.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11296.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13555.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36406.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27110.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11860.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37178.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12086.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":54605.47,"10th_percentile":54605.47,"90th_percentile":54605.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23636.03,"10th_percentile":23636.03,"90th_percentile":23826.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":37927.45,"10th_percentile":37927.45,"90th_percentile":37927.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11886.52,"10th_percentile":11886.52,"90th_percentile":11886.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17947.97,"maximum":91376.3,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18845.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19204.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19204.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43075.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37689.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78142.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29761.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91376.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69594.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19024.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42536.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21537.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17947.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19204.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17947.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21537.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60504.05},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43075.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18845.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61787.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19204.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":867.67,"10th_percentile":867.67,"90th_percentile":867.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":41918.33,"10th_percentile":41918.33,"90th_percentile":41918.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45859.24,"10th_percentile":45859.24,"90th_percentile":45859.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":29754.61,"10th_percentile":29754.61,"90th_percentile":29754.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47847.03,"10th_percentile":47847.03,"90th_percentile":47847.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17051.26,"10th_percentile":17051.26,"90th_percentile":17051.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18581.38,"10th_percentile":18581.38,"90th_percentile":18581.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16738.17,"10th_percentile":16738.17,"90th_percentile":16738.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":841.86,"10th_percentile":841.86,"90th_percentile":841.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32772.84,"maximum":131822.19,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34411.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35066.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35066.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":78654.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51051.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32772.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105845.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38468.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123771.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131822.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34739.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":77671.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39327.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":32772.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35066.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32772.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39327.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":114602.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":78654.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34411.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":117034.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35066.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31835.59,"10th_percentile":31835.59,"90th_percentile":31835.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":50686.01,"10th_percentile":50686.01,"90th_percentile":51486.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":97212.07,"10th_percentile":97212.07,"90th_percentile":97212.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":36449.51,"10th_percentile":36449.51,"90th_percentile":36449.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45476.08,"10th_percentile":45476.08,"90th_percentile":45476.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30294.19,"10th_percentile":29247.31,"90th_percentile":31256.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14697.89,"10th_percentile":14697.89,"90th_percentile":14697.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":1336.27,"10th_percentile":1336.27,"90th_percentile":1336.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45937.12,"10th_percentile":45937.12,"90th_percentile":45937.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":123246.59,"10th_percentile":123246.59,"90th_percentile":123246.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10916.67,"maximum":41199.46,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11462.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11680.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11680.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26200.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15330.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31785.02},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20867.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37168.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41199.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11571.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25872.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13100.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10916.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11680.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10916.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13100.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35817.73},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26200.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11462.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36577.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11680.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8528.73,"10th_percentile":8528.73,"90th_percentile":8528.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21372.84,"10th_percentile":21372.84,"90th_percentile":24797.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13649.72,"10th_percentile":13490.79,"90th_percentile":15823.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36525.53,"10th_percentile":36525.53,"90th_percentile":36525.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":1175.68,"10th_percentile":1175.68,"90th_percentile":1175.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1205.82,"10th_percentile":1205.82,"90th_percentile":1205.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10760.72,"10th_percentile":10760.72,"90th_percentile":10760.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10629.41,"10th_percentile":10629.41,"90th_percentile":10629.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10655.04,"10th_percentile":10655.04,"90th_percentile":10655.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10443.33,"10th_percentile":10443.33,"90th_percentile":10443.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13336.21,"maximum":52572.5,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14003.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14269.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14269.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32006.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21290.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44142.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25440.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51618.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52572.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14136.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31606.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16003.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14269.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13336.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16003.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45705.15},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32006.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14003.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46674.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14269.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24607.6,"10th_percentile":24607.6,"90th_percentile":24607.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13013.91,"10th_percentile":13013.91,"90th_percentile":13013.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":46260.42,"10th_percentile":46260.42,"90th_percentile":46260.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":29253.5,"10th_percentile":29253.5,"90th_percentile":29253.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13561.5,"10th_percentile":13561.5,"90th_percentile":13561.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13123.2,"10th_percentile":13123.2,"90th_percentile":13123.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":48190.84,"10th_percentile":48190.84,"90th_percentile":48190.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13130.94,"10th_percentile":11893.33,"90th_percentile":13191.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22082.12,"maximum":90638.18,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee 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schedule","standard_charge_dollar":63404.02},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38466.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74142.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90638.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23407.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52334.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26498.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22082.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23627.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22082.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26498.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":78798.47},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52997.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23186.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80470.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23627.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":30991.31,"10th_percentile":30991.31,"90th_percentile":30991.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26304.4,"10th_percentile":26304.4,"90th_percentile":26304.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89645.06,"10th_percentile":89645.06,"90th_percentile":89645.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20211.02,"10th_percentile":20211.02,"90th_percentile":20211.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":68508.92,"10th_percentile":68508.92,"90th_percentile":68508.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21588.97,"10th_percentile":21588.97,"90th_percentile":21588.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9645.95,"maximum":34072.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10128.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23150.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13547.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9645.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28088.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15053.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32845.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34072.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10224.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22860.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11575.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9645.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9645.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11575.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29621.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23150.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10128.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30250.4},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10321.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8333.34,"10th_percentile":8333.34,"90th_percentile":8333.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15977.77,"10th_percentile":15977.77,"90th_percentile":15977.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10126.24,"10th_percentile":10126.24,"90th_percentile":10126.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12203.89,"maximum":46502.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29289.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18808.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12203.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38995.93},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23268.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45600.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46502.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12936.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28923.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14644.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12203.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13058.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12203.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14644.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40428.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29289.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12814.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41285.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13058.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12305.88,"10th_percentile":12305.88,"90th_percentile":12305.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27226.1,"10th_percentile":27226.1,"90th_percentile":27226.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9865.47,"10th_percentile":9865.47,"90th_percentile":9865.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10178.96,"10th_percentile":10178.96,"90th_percentile":10178.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12154.0,"10th_percentile":12154.0,"90th_percentile":12154.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19141.24,"maximum":74783.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20098.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45938.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27693.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19141.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57417.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35411.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67142.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74783.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20289.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45364.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19141.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19141.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22969.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":65015.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45938.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20098.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66394.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20481.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17799.96,"10th_percentile":17799.96,"90th_percentile":17799.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57175.91,"10th_percentile":57175.91,"90th_percentile":57175.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17061.34,"10th_percentile":17061.34,"90th_percentile":17061.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20604.57,"10th_percentile":20604.57,"90th_percentile":20604.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7514.69,"maximum":31607.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18035.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13037.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7514.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27029.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18895.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31607.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27224.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7965.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17809.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7514.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7514.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23668.02},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18035.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7890.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24170.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8040.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6648.45,"10th_percentile":6648.45,"90th_percentile":6648.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10657.08,"maximum":46816.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25576.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19310.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40035.91},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18114.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46816.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38903.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11296.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25257.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10657.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11403.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10657.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12788.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33821.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25576.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11189.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34538.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11403.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":41351.02,"10th_percentile":39596.56,"90th_percentile":41368.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32243.76,"10th_percentile":32243.76,"90th_percentile":32243.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11680.28,"10th_percentile":11680.28,"90th_percentile":11680.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17733.55,"maximum":73139.77,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18620.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18974.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18974.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42560.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26678.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55312.89},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43844.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64680.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73139.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18797.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42028.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21280.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17733.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18974.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17733.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21280.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63585.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42560.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18620.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64934.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18974.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9777.9,"maximum":38482.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10266.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23466.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19062.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28054.27},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15291.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32805.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38482.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10364.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23173.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9777.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9777.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33456.03},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23466.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10266.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34165.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10462.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9111.17,"10th_percentile":9111.17,"90th_percentile":9111.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10002.33,"10th_percentile":10002.33,"90th_percentile":10002.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12061.9,"maximum":46215.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12665.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12906.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12906.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28948.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25726.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39522.18},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19074.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46215.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46023.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12785.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28586.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14474.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12061.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12906.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12061.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14474.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40011.83},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28948.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12665.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40860.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12906.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9816.12,"10th_percentile":9816.12,"90th_percentile":9816.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":848.61,"10th_percentile":848.61,"90th_percentile":848.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12188.4,"10th_percentile":12188.4,"90th_percentile":12188.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6833.5,"10th_percentile":6833.5,"90th_percentile":6833.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19793.1,"maximum":83270.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20782.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21178.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21178.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47503.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38006.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19793.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67541.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21702.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78980.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83270.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20980.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46909.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23751.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19793.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21178.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19793.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23751.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":72393.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47503.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20782.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73928.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21178.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":22555.69,"10th_percentile":22555.69,"90th_percentile":22555.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12279.19,"maximum":62211.78,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12893.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13138.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13138.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29470.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25660.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53201.62},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22088.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62211.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47439.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29101.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13138.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12279.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41242.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29470.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12893.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42117.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13138.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24399.19,"10th_percentile":24399.19,"90th_percentile":24399.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11852.43,"10th_percentile":11852.43,"90th_percentile":11852.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":55584.16,"10th_percentile":55584.16,"90th_percentile":55584.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23103.48,"10th_percentile":23103.48,"90th_percentile":23103.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12820.13,"10th_percentile":12820.13,"90th_percentile":12820.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":41324.91,"10th_percentile":41324.91,"90th_percentile":41324.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16393.26,"maximum":90753.6,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17212.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37432.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16393.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77609.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30474.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90753.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65283.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17376.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38852.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16393.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16393.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56755.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39343.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17212.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57960.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17540.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15638.43,"10th_percentile":15638.43,"90th_percentile":15638.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13907.29,"10th_percentile":13907.29,"90th_percentile":13907.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":28765.86,"10th_percentile":28765.86,"90th_percentile":28765.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15056.8,"10th_percentile":15056.8,"90th_percentile":15626.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":75386.96,"10th_percentile":70794.62,"90th_percentile":81887.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":29118.37,"10th_percentile":29118.37,"90th_percentile":29118.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64647.91,"10th_percentile":64647.91,"90th_percentile":64647.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14464.97,"10th_percentile":14331.29,"90th_percentile":16383.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16086.09,"10th_percentile":16086.09,"90th_percentile":16086.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":57574.8,"10th_percentile":57574.8,"90th_percentile":57574.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16008.29,"10th_percentile":16008.29,"90th_percentile":16208.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26878.89,"maximum":127416.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28222.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28760.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28760.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64509.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52554.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26878.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108962.45},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51258.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127416.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111996.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28491.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63702.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32254.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26878.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28760.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26878.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32254.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":97366.95},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64509.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28222.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":99432.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28760.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24114.88,"10th_percentile":24114.88,"90th_percentile":24114.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":87366.44,"10th_percentile":87366.44,"90th_percentile":87366.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":52302.94,"10th_percentile":52302.94,"90th_percentile":52302.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26800.29,"10th_percentile":26800.29,"90th_percentile":26861.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26833.59,"10th_percentile":26833.59,"90th_percentile":26833.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28000.35,"10th_percentile":28000.35,"90th_percentile":28000.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13017.1,"maximum":65405.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13667.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31241.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26977.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55933.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28935.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65405.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51252.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13798.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30850.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13017.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13017.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15620.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44557.89},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31241.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13667.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45503.18},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13928.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":57751.31,"10th_percentile":57751.31,"90th_percentile":58178.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12785.29,"10th_percentile":12785.29,"90th_percentile":12785.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18067.72,"maximum":94456.85,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18971.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43362.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38960.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80776.62},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32044.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94456.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65676.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19151.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42820.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21681.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18067.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21681.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57097.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43362.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18971.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58308.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19332.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36668.93,"10th_percentile":36668.93,"90th_percentile":36668.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16202.92,"10th_percentile":16202.92,"90th_percentile":16202.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":33240.73,"10th_percentile":33240.73,"90th_percentile":33240.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19299.93,"10th_percentile":19299.93,"90th_percentile":19299.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16336.34,"10th_percentile":16336.34,"90th_percentile":16336.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27236.01,"maximum":136038.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28597.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29142.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29142.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65366.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56111.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116336.25},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62817.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136038.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107193.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28870.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64549.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32683.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29142.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27236.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32683.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":93191.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65366.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28597.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95168.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29142.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13339.8,"maximum":60438.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14006.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14273.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14273.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32015.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24928.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51685.51},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24164.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60438.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51024.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14140.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31615.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16007.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13339.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14273.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13339.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16007.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44359.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32015.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14006.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45300.14},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14273.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12947.05,"10th_percentile":12947.05,"90th_percentile":13102.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17159.65,"10th_percentile":17159.65,"90th_percentile":17159.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":43001.82,"10th_percentile":43001.82,"90th_percentile":67657.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12799.68,"10th_percentile":12799.68,"90th_percentile":13325.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30074.77,"10th_percentile":26449.25,"90th_percentile":32791.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"11","median_amount":25050.28,"10th_percentile":22185.88,"90th_percentile":25686.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12288.19,"10th_percentile":12288.19,"90th_percentile":23826.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"38","median_amount":52097.78,"10th_percentile":31356.06,"90th_percentile":54915.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"30","median_amount":24959.55,"10th_percentile":22794.19,"90th_percentile":26053.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":63300.0,"10th_percentile":63300.0,"90th_percentile":71667.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52282.35,"10th_percentile":51371.41,"90th_percentile":54069.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":12945.89,"10th_percentile":11935.02,"90th_percentile":13673.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28115.13,"10th_percentile":28115.13,"90th_percentile":28398.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14550.94,"10th_percentile":14550.94,"90th_percentile":14550.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54.96,"10th_percentile":54.96,"90th_percentile":54.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14398.71,"10th_percentile":14398.71,"90th_percentile":14398.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":46254.99,"10th_percentile":45626.83,"90th_percentile":46734.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12818.29,"10th_percentile":12007.67,"90th_percentile":13948.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":46493.01,"10th_percentile":46493.01,"90th_percentile":46493.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14659.15,"10th_percentile":14659.15,"90th_percentile":14659.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18462.14,"maximum":91574.1,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19754.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19754.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44309.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37771.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18462.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78311.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31075.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91574.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73050.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19569.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43755.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22154.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18462.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19754.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18462.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22154.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63507.89},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44309.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19385.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64855.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19754.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17835.88,"10th_percentile":10674.0,"90th_percentile":18122.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":86348.21,"10th_percentile":28277.34,"90th_percentile":106274.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18575.3,"10th_percentile":17300.84,"90th_percentile":18585.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45608.45,"10th_percentile":45608.45,"90th_percentile":45608.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"12","median_amount":34962.93,"10th_percentile":30217.36,"90th_percentile":38168.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17093.14,"10th_percentile":17093.14,"90th_percentile":17093.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"33","median_amount":78631.13,"10th_percentile":62493.65,"90th_percentile":83042.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"18","median_amount":31045.59,"10th_percentile":29512.08,"90th_percentile":32951.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":57495.1,"10th_percentile":57495.1,"90th_percentile":57495.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":16942.78,"10th_percentile":16942.78,"90th_percentile":16942.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":76192.44,"10th_percentile":76192.44,"90th_percentile":76192.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18029.63,"10th_percentile":18029.63,"90th_percentile":18029.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":17411.03,"10th_percentile":16247.3,"90th_percentile":18328.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37416.5,"10th_percentile":37416.5,"90th_percentile":37558.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":507.36,"10th_percentile":507.36,"90th_percentile":507.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18059.41,"10th_percentile":18059.41,"90th_percentile":18059.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20727.33,"10th_percentile":20727.33,"90th_percentile":20727.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":20638.32,"10th_percentile":18559.62,"90th_percentile":30170.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":62498.92,"10th_percentile":61997.29,"90th_percentile":99598.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":17624.1,"10th_percentile":12357.21,"90th_percentile":17954.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":65632.44,"10th_percentile":65632.44,"90th_percentile":65632.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17829.8,"10th_percentile":17646.64,"90th_percentile":18256.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34233.6,"maximum":150181.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35945.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36629.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36629.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82160.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":61944.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34233.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128430.66},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49157.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150181.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141906.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36287.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81133.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41080.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":34233.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36629.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34233.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41080.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":123369.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82160.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35945.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":125987.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36629.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31624.8,"10th_percentile":26825.16,"90th_percentile":33168.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26089.2,"10th_percentile":1713.95,"90th_percentile":42368.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84900.41,"10th_percentile":84900.41,"90th_percentile":84900.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":60699.11,"10th_percentile":60179.53,"90th_percentile":61161.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32633.46,"10th_percentile":32633.46,"90th_percentile":34346.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"22","median_amount":100408.81,"10th_percentile":75536.85,"90th_percentile":168356.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"15","median_amount":49925.39,"10th_percentile":46599.46,"90th_percentile":50873.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":82571.91,"10th_percentile":82571.91,"90th_percentile":82571.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":27237.49,"10th_percentile":27237.49,"90th_percentile":28252.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":117850.94,"10th_percentile":117850.94,"90th_percentile":145556.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":31457.94,"10th_percentile":25148.76,"90th_percentile":33152.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71800.82,"10th_percentile":70939.29,"90th_percentile":314023.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":30447.68,"10th_percentile":30447.68,"90th_percentile":30447.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47680.7,"10th_percentile":47680.7,"90th_percentile":47680.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":48878.89,"10th_percentile":48878.89,"90th_percentile":48878.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":94013.44,"10th_percentile":89819.86,"90th_percentile":141846.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":32993.87,"10th_percentile":18346.5,"90th_percentile":35464.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49908.38,"10th_percentile":49908.38,"90th_percentile":49908.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8926.68,"maximum":34618.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9551.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9551.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21424.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14278.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29604.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11536.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34618.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33083.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9462.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21156.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10712.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8926.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9551.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8926.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10712.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28762.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21424.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9373.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29372.38},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9551.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9349.6,"10th_percentile":9349.6,"90th_percentile":9349.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6746.55,"10th_percentile":6746.55,"90th_percentile":6930.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16270.34,"10th_percentile":13889.62,"90th_percentile":16768.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":14475.8,"10th_percentile":14475.8,"90th_percentile":15154.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8160.28,"10th_percentile":8160.28,"90th_percentile":8160.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36561.91,"10th_percentile":26371.53,"90th_percentile":39809.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11573.69,"10th_percentile":9424.26,"90th_percentile":11780.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":42259.32,"10th_percentile":42259.32,"90th_percentile":42259.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26661.65,"10th_percentile":26661.65,"90th_percentile":26661.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5652.36,"10th_percentile":394.97,"90th_percentile":8656.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15263.54,"10th_percentile":10626.13,"90th_percentile":16977.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9713.86,"10th_percentile":9713.86,"90th_percentile":9713.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5992.22,"10th_percentile":5992.22,"90th_percentile":5992.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":2349.9,"10th_percentile":2349.9,"90th_percentile":2349.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":8190.1,"10th_percentile":728.68,"90th_percentile":8527.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8527.11,"10th_percentile":8527.11,"90th_percentile":8737.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12979.81,"maximum":49995.02,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13888.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13888.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31151.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18462.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38278.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16077.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44761.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49995.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13758.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30762.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15575.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12979.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13888.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15575.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43464.36},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31151.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44386.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13888.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13237.27,"10th_percentile":13237.27,"90th_percentile":13237.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10018.97,"10th_percentile":10018.97,"90th_percentile":10018.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29031.45,"10th_percentile":29031.45,"90th_percentile":29031.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":18659.32,"10th_percentile":18659.32,"90th_percentile":18714.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1807.74,"10th_percentile":1807.74,"90th_percentile":1807.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":38694.7,"10th_percentile":34240.83,"90th_percentile":40352.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":15424.05,"10th_percentile":14651.63,"90th_percentile":94730.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10300.31,"10th_percentile":10300.31,"90th_percentile":12482.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24135.32,"10th_percentile":24135.32,"90th_percentile":24135.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":670.6,"10th_percentile":670.6,"90th_percentile":670.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12251.33,"10th_percentile":6702.2,"90th_percentile":12505.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13572.42,"10th_percentile":13572.42,"90th_percentile":13572.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":3924.13,"10th_percentile":3924.13,"90th_percentile":3924.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10549.14,"10th_percentile":1437.03,"90th_percentile":12250.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4535.08,"maximum":26398.98,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4761.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10888.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22575.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7624.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26398.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13647.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4807.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10748.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":4535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4852.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4535.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5442.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":11864.91},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10884.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4761.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":12116.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4852.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5818.0,"maximum":31098.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6108.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13963.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12827.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26594.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12491.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31098.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21769.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6167.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13788.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5818.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18925.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13963.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6108.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19327.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6225.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12472.09,"maximum":50631.66,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13095.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13345.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13345.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29933.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16836.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34908.08},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20688.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40820.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50631.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13220.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29558.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14966.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12472.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13345.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14966.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44017.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29933.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13095.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44951.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13345.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12594.94,"10th_percentile":12594.94,"90th_percentile":12594.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12865.34,"10th_percentile":12865.34,"90th_percentile":12865.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12159.79,"10th_percentile":12159.79,"90th_percentile":12159.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13011.86,"10th_percentile":13011.86,"90th_percentile":13011.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":44942.88,"10th_percentile":44942.88,"90th_percentile":44942.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13337.38,"10th_percentile":13337.38,"90th_percentile":13337.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10500.37,"maximum":25457.6,"payers_information":[{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10500.37},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21770.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10819.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25457.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24408.77},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21220.35},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21670.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13091.46,"maximum":37948.25,"payers_information":[{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13091.46},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27142.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18697.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31739.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37948.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32991.22},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33691.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5330.36,"maximum":32105.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5596.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12792.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13242.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5330.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27455.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7126.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32105.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16966.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5650.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12632.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6396.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5330.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5330.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6396.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":14750.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12792.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5596.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15063.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5703.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95.41,"10th_percentile":95.41,"90th_percentile":95.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1845.85,"10th_percentile":1845.85,"90th_percentile":1845.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3895.92,"10th_percentile":3895.92,"90th_percentile":3895.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5001.33,"10th_percentile":5001.33,"90th_percentile":5001.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5018.02,"10th_percentile":5018.02,"90th_percentile":5018.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1988.74,"10th_percentile":1988.74,"90th_percentile":1988.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":15473.17,"10th_percentile":15473.17,"90th_percentile":15473.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4269.28,"10th_percentile":4269.28,"90th_percentile":4269.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7359.79,"maximum":37120.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7727.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7874.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7874.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17663.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15310.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31744.3},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8823.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37120.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26618.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7801.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17442.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8831.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7359.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7874.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7359.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8831.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23141.41},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17663.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7727.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23632.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7874.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6714.98,"10th_percentile":6714.98,"90th_percentile":6714.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2039.2,"10th_percentile":2039.2,"90th_percentile":2039.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16775.48,"10th_percentile":16775.48,"90th_percentile":16775.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":29071.8,"10th_percentile":29071.8,"90th_percentile":29071.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9023.44,"10th_percentile":9023.44,"90th_percentile":9023.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12296.96,"10th_percentile":12296.96,"90th_percentile":12296.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12351.85,"10th_percentile":12351.85,"90th_percentile":12351.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5649.18,"10th_percentile":5649.18,"90th_percentile":7004.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9575.41,"10th_percentile":9575.41,"90th_percentile":9575.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10477.8,"maximum":46098.4,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11211.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11211.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25146.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19013.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10477.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39421.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12401.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46098.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40327.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11106.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24832.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10477.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11211.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10477.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35060.05},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25146.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11001.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35803.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11211.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":9689.92,"10th_percentile":1841.04,"90th_percentile":10164.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":10268.2,"10th_percentile":7621.44,"90th_percentile":10438.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":36477.17,"10th_percentile":36477.17,"90th_percentile":36477.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"60","median_amount":9788.69,"10th_percentile":506.15,"90th_percentile":11107.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"34","median_amount":21215.57,"10th_percentile":299.52,"90th_percentile":24365.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"17","median_amount":18744.75,"10th_percentile":15949.7,"90th_percentile":27349.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"42","median_amount":9212.13,"10th_percentile":518.97,"90th_percentile":10208.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"32","median_amount":28500.07,"10th_percentile":16866.46,"90th_percentile":43108.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"17","median_amount":12226.23,"10th_percentile":10120.8,"90th_percentile":12601.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":21981.02,"10th_percentile":21981.02,"90th_percentile":21981.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":8981.94,"10th_percentile":156.12,"90th_percentile":20631.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35447.67,"10th_percentile":35447.67,"90th_percentile":35447.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":9194.51,"10th_percentile":9194.51,"90th_percentile":9194.51},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9314.2,"10th_percentile":9314.2,"90th_percentile":9314.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"148","median_amount":8409.91,"10th_percentile":491.91,"90th_percentile":10321.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20499.45,"10th_percentile":18148.95,"90th_percentile":22884.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":10081.51,"10th_percentile":7279.89,"90th_percentile":11774.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11519.91,"10th_percentile":11519.91,"90th_percentile":11748.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"60","median_amount":10362.8,"10th_percentile":9963.36,"90th_percentile":11162.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10530.78,"10th_percentile":10400.66,"90th_percentile":10670.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9737.89,"10th_percentile":529.23,"90th_percentile":10453.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12123.14,"10th_percentile":12123.14,"90th_percentile":12540.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"24","median_amount":9773.13,"10th_percentile":135.59,"90th_percentile":9801.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":36068.92,"10th_percentile":844.44,"90th_percentile":36618.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"203","median_amount":9695.84,"10th_percentile":806.4,"90th_percentile":10523.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":14861.07,"10th_percentile":14861.07,"90th_percentile":14861.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":9021.82,"10th_percentile":8527.44,"90th_percentile":11283.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7938.5,"maximum":72281.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8335.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19052.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29813.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7938.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61812.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17593.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72281.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30256.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18814.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7938.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7938.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9526.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26303.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19052.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8335.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26861.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8494.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13511.9,"maximum":84522.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32428.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34862.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13511.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72281.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18338.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84522.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48724.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32023.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16214.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13511.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13511.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16214.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42360.09},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32428.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14187.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43258.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14457.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12034.61,"10th_percentile":12034.61,"90th_percentile":12034.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18067.53,"maximum":106749.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21711.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22125.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22125.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49627.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44030.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20678.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91289.14},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18067.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106749.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84410.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21918.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49006.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24813.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20678.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22125.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20678.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24813.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":73384.57},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49627.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21711.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74941.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22125.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29518.96,"10th_percentile":29518.96,"90th_percentile":29518.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8945.33,"maximum":41801.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21468.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17241.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35747.58},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15627.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41801.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33674.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9482.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21200.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8945.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8945.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29275.37},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21468.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29896.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9571.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8297.27,"10th_percentile":617.49,"90th_percentile":8637.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8778.24,"10th_percentile":8778.24,"90th_percentile":8778.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":37364.94,"10th_percentile":37364.94,"90th_percentile":37364.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8858.73,"10th_percentile":8858.73,"90th_percentile":9500.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16964.71,"10th_percentile":235.59,"90th_percentile":20248.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12948.63,"10th_percentile":9836.55,"90th_percentile":17438.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8101.01,"10th_percentile":1253.56,"90th_percentile":9123.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"32","median_amount":35663.68,"10th_percentile":32958.65,"90th_percentile":39434.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"16","median_amount":14879.02,"10th_percentile":7034.61,"90th_percentile":15870.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":42200.07,"10th_percentile":39887.34,"90th_percentile":43658.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33657.53,"10th_percentile":33657.53,"90th_percentile":33657.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":2872.93,"10th_percentile":278.48,"90th_percentile":9407.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15918.47,"10th_percentile":15661.03,"90th_percentile":17155.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8614.04,"10th_percentile":8504.57,"90th_percentile":9200.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":27073.48,"10th_percentile":25659.94,"90th_percentile":29745.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":7424.37,"10th_percentile":3802.12,"90th_percentile":8660.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":28687.31,"10th_percentile":28687.31,"90th_percentile":28687.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9551.05,"10th_percentile":9551.05,"90th_percentile":9551.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17139.78,"maximum":68402.04,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17996.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18339.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18339.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41135.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25181.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52208.63},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21237.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61050.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68402.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18168.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40621.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20567.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17139.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18339.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17139.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20567.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59466.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41135.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17996.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60728.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18339.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16297.6,"10th_percentile":16297.6,"90th_percentile":17060.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15950.73,"10th_percentile":15950.73,"90th_percentile":23563.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":76010.53,"10th_percentile":76010.53,"90th_percentile":76010.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16036.15,"10th_percentile":8256.84,"90th_percentile":18413.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":31509.45,"10th_percentile":478.93,"90th_percentile":41470.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24288.69,"10th_percentile":21192.48,"90th_percentile":32451.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15497.55,"10th_percentile":15207.75,"90th_percentile":16144.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"16","median_amount":50703.77,"10th_percentile":23861.24,"90th_percentile":53338.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":20774.56,"10th_percentile":19904.19,"90th_percentile":21237.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13990.54,"10th_percentile":13990.54,"90th_percentile":13990.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53231.78,"10th_percentile":48080.09,"90th_percentile":66647.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15456.58,"10th_percentile":2548.22,"90th_percentile":17259.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34760.36,"10th_percentile":34760.36,"90th_percentile":34760.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15660.72,"10th_percentile":15660.72,"90th_percentile":15660.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":16335.79,"10th_percentile":12405.2,"90th_percentile":17720.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15700.71,"10th_percentile":15700.71,"90th_percentile":15700.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18989.15,"10th_percentile":15254.05,"90th_percentile":30333.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":56399.86,"10th_percentile":56399.86,"90th_percentile":59466.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":16301.4,"10th_percentile":14798.46,"90th_percentile":16493.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":55269.05,"10th_percentile":55269.05,"90th_percentile":55269.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15340.53,"10th_percentile":15340.53,"90th_percentile":15526.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5566.29,"maximum":38171.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5844.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13359.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15744.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32643.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8438.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38171.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17346.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5900.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13192.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5566.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5566.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15081.01},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13359.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5844.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15400.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6235.36,"maximum":44226.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6547.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14964.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18241.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37821.26},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12717.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44226.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22897.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6609.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14777.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7482.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6235.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7482.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19906.5},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14964.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6547.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20328.81},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15476.08,"maximum":60431.64,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16249.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37142.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23851.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49452.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21079.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57827.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60431.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16404.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36678.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18571.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15476.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18571.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52537.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37142.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16249.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53652.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16559.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6456.94,"maximum":38889.69,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15496.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16040.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6456.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33257.27},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12010.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38889.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22409.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6844.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15302.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6456.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6456.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19481.99},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15496.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6779.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19895.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6908.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5826.14,"10th_percentile":5826.14,"90th_percentile":5826.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":27965.22,"10th_percentile":27965.22,"90th_percentile":27965.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6273.15,"10th_percentile":6273.15,"90th_percentile":6273.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14491.64,"10th_percentile":14491.64,"90th_percentile":14491.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12612.34,"10th_percentile":8819.52,"90th_percentile":17827.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5777.45,"10th_percentile":5258.25,"90th_percentile":6179.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":32508.93,"10th_percentile":23287.69,"90th_percentile":37966.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11133.18,"10th_percentile":10761.65,"90th_percentile":11959.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17980.87,"10th_percentile":17980.87,"90th_percentile":17980.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6045.83,"10th_percentile":2319.01,"90th_percentile":6908.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10561.49,"10th_percentile":10561.49,"90th_percentile":10561.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6237.5,"10th_percentile":6166.47,"90th_percentile":12893.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":163.93,"10th_percentile":163.93,"90th_percentile":163.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1689.1,"10th_percentile":1689.1,"90th_percentile":1689.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5812.89,"10th_percentile":4470.46,"90th_percentile":6166.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":18857.79,"10th_percentile":18857.79,"90th_percentile":18857.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7862.49,"maximum":48080.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18869.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19831.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7862.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41116.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13538.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48080.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28488.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8334.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18634.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9434.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7862.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7862.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9434.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24766.92},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18869.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8255.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25292.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8412.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6858.96,"10th_percentile":6858.96,"90th_percentile":6858.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8748.55,"10th_percentile":8748.55,"90th_percentile":8748.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7288.23,"10th_percentile":3881.45,"90th_percentile":7768.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17586.27,"10th_percentile":17586.27,"90th_percentile":17586.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19303.4,"10th_percentile":17893.77,"90th_percentile":20312.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7359.15,"10th_percentile":7324.11,"90th_percentile":7359.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"16","median_amount":41330.73,"10th_percentile":26855.45,"90th_percentile":42314.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11537.35,"10th_percentile":11537.35,"90th_percentile":11537.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":41717.27,"10th_percentile":41717.27,"90th_percentile":41717.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33105.44,"10th_percentile":33105.44,"90th_percentile":33105.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6576.46,"10th_percentile":6428.07,"90th_percentile":7769.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13790.96,"10th_percentile":13159.11,"90th_percentile":14831.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15345.47,"10th_percentile":15345.47,"90th_percentile":15345.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8573.38,"10th_percentile":8573.38,"90th_percentile":8573.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7482.43,"10th_percentile":7348.15,"90th_percentile":8433.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7158.25,"10th_percentile":7158.25,"90th_percentile":7158.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15254.05,"10th_percentile":15254.05,"90th_percentile":15254.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":16912.76,"10th_percentile":16912.76,"90th_percentile":23242.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":7450.01,"10th_percentile":5650.64,"90th_percentile":8224.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":25267.77,"10th_percentile":25267.77,"90th_percentile":25267.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12774.71,"maximum":63702.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13413.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30659.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26275.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54476.52},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18951.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63702.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50730.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13541.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30276.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15329.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12774.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12774.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15329.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44103.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30659.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13413.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45039.48},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12391.37,"10th_percentile":8909.26,"90th_percentile":12482.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10241.53,"10th_percentile":494.22,"90th_percentile":12509.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":29325.43,"10th_percentile":21832.49,"90th_percentile":33650.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":26705.8,"10th_percentile":20405.49,"90th_percentile":56576.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11451.97,"10th_percentile":7498.89,"90th_percentile":12296.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"13","median_amount":37448.65,"10th_percentile":21652.05,"90th_percentile":58091.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"11","median_amount":18951.18,"10th_percentile":16329.85,"90th_percentile":19398.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":76428.02,"10th_percentile":76428.02,"90th_percentile":76428.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":16251.47,"10th_percentile":16251.47,"90th_percentile":16251.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42619.38,"10th_percentile":42619.38,"90th_percentile":42619.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":10843.0,"10th_percentile":611.17,"90th_percentile":12691.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25880.76,"10th_percentile":23907.87,"90th_percentile":26586.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18221.54,"10th_percentile":18221.54,"90th_percentile":18221.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15208.74,"10th_percentile":15208.74,"90th_percentile":15208.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":12622.6,"10th_percentile":12326.68,"90th_percentile":13252.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11985.6,"10th_percentile":11914.47,"90th_percentile":12020.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15161.91,"10th_percentile":15161.91,"90th_percentile":15161.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":23234.31,"10th_percentile":23234.31,"90th_percentile":23234.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"11","median_amount":27786.63,"10th_percentile":17368.64,"90th_percentile":44466.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"51","median_amount":11431.96,"10th_percentile":7224.5,"90th_percentile":12621.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11049.71,"10th_percentile":11049.71,"90th_percentile":11414.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27133.47,"maximum":99025.8,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28490.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29032.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29032.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65120.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32137.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27133.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66630.45},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73411.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77914.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99025.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28761.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64306.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32560.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27133.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29032.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27133.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32560.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":86090.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65120.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28490.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87916.84},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29032.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":73641.02,"10th_percentile":73641.02,"90th_percentile":73641.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":81134.31,"10th_percentile":81134.31,"90th_percentile":81134.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22407.38,"10th_percentile":22407.38,"90th_percentile":28357.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27831.89,"10th_percentile":27831.89,"90th_percentile":27831.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23240.82,"10th_percentile":23240.82,"90th_percentile":23240.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41187.45,"maximum":154614.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed 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Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36043.51,"10th_percentile":36043.51,"90th_percentile":36043.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34391.37,"maximum":197979.54,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36110.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36798.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36798.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82539.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81659.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34391.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169306.06},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64323.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197979.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143776.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36454.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81507.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41269.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":34391.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36798.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34391.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41269.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":124995.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82539.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36110.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":127647.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36798.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32654.42,"10th_percentile":32654.42,"90th_percentile":32654.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":214582.04,"10th_percentile":214582.04,"90th_percentile":214582.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114863.71,"10th_percentile":114863.71,"90th_percentile":114863.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":170291.74,"10th_percentile":170291.74,"90th_percentile":170291.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":65579.77,"10th_percentile":65579.77,"90th_percentile":66203.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34333.82,"10th_percentile":34333.82,"90th_percentile":34333.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":70519.27,"10th_percentile":70519.27,"90th_percentile":70519.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33335.54,"10th_percentile":33335.54,"90th_percentile":33335.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":131566.63,"10th_percentile":131566.63,"90th_percentile":131566.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33360.55,"10th_percentile":33360.55,"90th_percentile":33360.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36489.76,"10th_percentile":36489.76,"90th_percentile":36489.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44345.62,"maximum":214440.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46562.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47449.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47449.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":106429.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":89810.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44345.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183383.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83710.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214440.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191425.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47006.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105099.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53214.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":44345.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47449.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44345.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53214.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":166420.39},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":106429.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46562.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":169950.97},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47449.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43364.74,"10th_percentile":43364.74,"90th_percentile":43364.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33517.33,"10th_percentile":33517.33,"90th_percentile":33517.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":108782.69,"10th_percentile":108782.69,"90th_percentile":108782.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":184785.74,"10th_percentile":184785.74,"90th_percentile":184785.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42937.88,"10th_percentile":42937.88,"90th_percentile":44830.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43693.77,"10th_percentile":43693.77,"90th_percentile":43693.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":52973.07,"10th_percentile":52973.07,"90th_percentile":52973.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46947.93,"10th_percentile":46947.93,"90th_percentile":46947.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52404.53,"maximum":279912.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55024.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56072.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56072.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":125770.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":115454.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52404.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":239372.81},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102732.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":279912.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":218390.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55548.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":124198.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62885.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":52404.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56072.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52404.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62885.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":189862.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":125770.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55024.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":193890.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56072.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51909.12,"10th_percentile":51909.12,"90th_percentile":51909.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":256625.79,"10th_percentile":256625.79,"90th_percentile":256625.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52895.9,"10th_percentile":52895.9,"90th_percentile":52895.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":106069.58,"10th_percentile":106069.58,"90th_percentile":106069.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49066.35,"10th_percentile":49066.35,"90th_percentile":49066.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":233688.91,"10th_percentile":233688.91,"90th_percentile":233688.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":102246.87,"10th_percentile":102246.87,"90th_percentile":102246.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49581.48,"10th_percentile":49581.48,"90th_percentile":49581.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":191136.14,"10th_percentile":191136.14,"90th_percentile":191136.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54012.69,"10th_percentile":50342.95,"90th_percentile":56800.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":186152.32,"10th_percentile":186152.32,"90th_percentile":186152.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24876.71,"maximum":96448.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26120.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26618.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26618.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26409.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24876.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54755.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56423.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64028.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96448.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26369.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58957.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24876.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26618.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24876.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29852.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":83849.65},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26120.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85628.51},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26618.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22724.82,"10th_percentile":1539.6,"90th_percentile":22879.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23192.71,"10th_percentile":23161.71,"90th_percentile":26281.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":27091.76,"10th_percentile":20103.47,"90th_percentile":32720.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22366.96,"10th_percentile":21967.23,"90th_percentile":28893.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":55808.44,"10th_percentile":53837.64,"90th_percentile":57231.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":54616.99,"10th_percentile":53591.88,"90th_percentile":62882.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":66589.76,"10th_percentile":66589.76,"90th_percentile":66589.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12247.95,"10th_percentile":12247.95,"90th_percentile":12247.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":22997.96,"10th_percentile":22674.77,"90th_percentile":25912.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46818.03,"10th_percentile":46818.03,"90th_percentile":46818.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22277.28,"10th_percentile":22277.28,"90th_percentile":22449.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":84038.04,"10th_percentile":84038.04,"90th_percentile":84038.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":22535.77,"10th_percentile":1179.58,"90th_percentile":25303.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23292.17,"10th_percentile":23292.17,"90th_percentile":23292.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30856.0,"maximum":120838.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32398.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37574.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30856.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77904.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61115.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91097.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120838.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32707.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":73128.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37027.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":30856.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33015.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30856.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37027.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":105053.88},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32398.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":107282.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33015.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1759.07,"10th_percentile":1759.07,"90th_percentile":1759.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":65763.2,"10th_percentile":65763.2,"90th_percentile":65763.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27563.04,"10th_percentile":27563.04,"90th_percentile":34488.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":77868.66,"10th_percentile":77124.34,"90th_percentile":79729.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30670.54,"10th_percentile":27505.07,"90th_percentile":32076.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":59628.52,"10th_percentile":59628.52,"90th_percentile":59628.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28863.91,"10th_percentile":27378.45,"90th_percentile":28988.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":25791.13,"10th_percentile":25791.13,"90th_percentile":25791.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":113742.86,"10th_percentile":113742.86,"90th_percentile":113742.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28461.67,"10th_percentile":21421.81,"90th_percentile":35390.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19579.4,"maximum":77324.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee 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schedule","standard_charge_dollar":59259.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38723.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69295.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77324.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20754.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46403.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23495.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19579.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20949.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19579.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23495.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":67223.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46990.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20558.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68649.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20949.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21326.58,"10th_percentile":21326.58,"90th_percentile":21326.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44637.52,"10th_percentile":44637.52,"90th_percentile":44637.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":62200.94,"10th_percentile":62200.94,"90th_percentile":62200.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":27469.62,"10th_percentile":27469.62,"90th_percentile":27469.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19480.48,"10th_percentile":19480.48,"90th_percentile":19480.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18372.53,"10th_percentile":18372.53,"90th_percentile":18372.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30.0,"10th_percentile":30.0,"90th_percentile":30.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17290.23,"10th_percentile":17290.23,"90th_percentile":17290.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18813.81,"10th_percentile":18813.81,"90th_percentile":18813.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26774.19,"maximum":116815.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28112.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28648.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28648.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64258.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48182.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26774.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99897.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45755.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116815.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106449.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28380.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63454.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32129.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26774.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28648.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26774.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32129.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":92544.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64258.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28112.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94507.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28648.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25413.17,"10th_percentile":25413.17,"90th_percentile":25413.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29632.59,"10th_percentile":29632.59,"90th_percentile":29632.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":48213.98,"10th_percentile":48213.98,"90th_percentile":48213.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33220.61,"10th_percentile":33220.61,"90th_percentile":33220.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":102027.57,"10th_percentile":102027.57,"90th_percentile":102027.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":43877.97,"10th_percentile":43877.97,"90th_percentile":45955.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21076.14,"10th_percentile":21076.14,"90th_percentile":21076.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25448.11,"10th_percentile":23687.95,"90th_percentile":26967.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54476.53,"10th_percentile":53788.83,"90th_percentile":55101.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27351.68,"10th_percentile":24912.52,"90th_percentile":124539.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31648.68,"10th_percentile":31648.68,"90th_percentile":31648.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":94578.46,"10th_percentile":94578.46,"90th_percentile":94578.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25013.98,"10th_percentile":25013.98,"90th_percentile":27744.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":48673.03,"10th_percentile":48673.03,"90th_percentile":48673.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24161.0,"10th_percentile":24161.0,"90th_percentile":24161.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39108.54,"maximum":164664.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41846.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41846.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":93860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67918.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39108.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140816.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67040.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164664.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":158629.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41455.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":92687.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46930.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":39108.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41846.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39108.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46930.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":137908.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":93860.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":140833.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41846.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40130.96,"10th_percentile":40130.96,"90th_percentile":54383.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35494.29,"10th_percentile":1669.32,"90th_percentile":39179.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":113867.87,"10th_percentile":113867.87,"90th_percentile":165717.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":64506.1,"10th_percentile":64015.31,"90th_percentile":67730.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40933.29,"10th_percentile":40933.29,"90th_percentile":40933.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":139109.25,"10th_percentile":134365.68,"90th_percentile":151743.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":68340.3,"10th_percentile":64324.67,"90th_percentile":70429.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":163709.48,"10th_percentile":163709.48,"90th_percentile":163709.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39216.79,"10th_percentile":34469.69,"90th_percentile":76249.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":79343.21,"10th_percentile":79343.21,"90th_percentile":80396.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":64996.91,"10th_percentile":64996.91,"90th_percentile":64996.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40276.9,"10th_percentile":36479.65,"90th_percentile":71042.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36980.85,"10th_percentile":35125.92,"90th_percentile":95466.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37515.95,"10th_percentile":37515.95,"90th_percentile":37515.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31556.62,"maximum":128577.16,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33765.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33765.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75735.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48182.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31556.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99897.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69891.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116815.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128577.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33450.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74789.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37867.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31556.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33765.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31556.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37867.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":111781.63},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75735.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33134.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114153.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33765.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30147.68,"10th_percentile":29875.1,"90th_percentile":34321.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30958.12,"10th_percentile":30958.12,"90th_percentile":30958.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":125792.1,"10th_percentile":125792.1,"90th_percentile":125792.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":70701.45,"10th_percentile":68580.94,"90th_percentile":71505.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36767.68,"10th_percentile":36767.68,"90th_percentile":36767.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5820.6,"10th_percentile":5820.6,"90th_percentile":5820.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29870.42,"10th_percentile":29870.42,"90th_percentile":29870.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30037.47,"10th_percentile":29560.24,"90th_percentile":30150.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30927.43,"10th_percentile":30927.43,"90th_percentile":30927.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50593.82,"maximum":206049.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53123.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54135.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54135.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":121425.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67918.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50593.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140816.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128347.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164664.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206049.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53629.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":119907.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":50593.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54135.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50593.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60712.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":179134.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":121425.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53123.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":182934.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54135.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63672.2,"10th_percentile":63672.2,"90th_percentile":63672.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48026.94,"10th_percentile":48026.94,"90th_percentile":48026.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":122965.96,"10th_percentile":122965.96,"90th_percentile":122965.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47438.14,"10th_percentile":47438.14,"90th_percentile":47438.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35411.82,"maximum":167811.37,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37182.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37890.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37890.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":84988.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":114541.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143507.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59463.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167811.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145389.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37536.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":83926.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42494.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":35411.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37890.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35411.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42494.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":126397.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":84988.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37182.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":129079.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37890.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33515.47,"10th_percentile":33282.27,"90th_percentile":36333.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":34449.19,"10th_percentile":33480.24,"90th_percentile":37145.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":110101.7,"10th_percentile":110101.7,"90th_percentile":110101.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32688.54,"10th_percentile":32688.35,"90th_percentile":33041.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":143507.16,"10th_percentile":137987.66,"90th_percentile":145793.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":59424.11,"10th_percentile":58602.7,"90th_percentile":59463.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":167811.37,"10th_percentile":167811.37,"90th_percentile":167811.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":133970.73,"10th_percentile":133970.73,"90th_percentile":133970.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":33933.52,"10th_percentile":33515.66,"90th_percentile":36512.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4110.94,"10th_percentile":4110.94,"90th_percentile":4110.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32993.91,"10th_percentile":32993.91,"90th_percentile":35571.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":124903.25,"10th_percentile":124903.25,"90th_percentile":124903.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":33308.16,"10th_percentile":31998.3,"90th_percentile":35745.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33449.27,"10th_percentile":33449.27,"90th_percentile":33449.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45219.06,"maximum":230821.68,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47480.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48384.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48384.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":108525.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":140568.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45219.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197391.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68027.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230821.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":185133.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47932.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":107169.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54262.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":45219.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48384.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45219.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54262.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":160950.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":108525.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47480.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":164364.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48384.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42437.44,"10th_percentile":41407.35,"90th_percentile":46726.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44563.99,"10th_percentile":44563.99,"90th_percentile":46064.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99728.4,"10th_percentile":99728.4,"90th_percentile":99728.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41200.15,"10th_percentile":32912.0,"90th_percentile":41705.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":155455.09,"10th_percentile":155455.09,"90th_percentile":155455.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":65262.51,"10th_percentile":65262.51,"90th_percentile":65262.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43162.52,"10th_percentile":41105.02,"90th_percentile":53598.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92738.97,"10th_percentile":92738.97,"90th_percentile":92738.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17656.99,"10th_percentile":17656.99,"90th_percentile":17656.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42160.61,"10th_percentile":41822.18,"90th_percentile":52721.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48722.11,"10th_percentile":48722.11,"90th_percentile":48722.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":88914.49,"10th_percentile":88914.49,"90th_percentile":88914.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":41025.42,"10th_percentile":33131.91,"90th_percentile":52792.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44131.14,"10th_percentile":43602.97,"90th_percentile":47803.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27218.09,"maximum":113819.28,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29123.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29123.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65323.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46946.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97334.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61347.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113819.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110235.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28851.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64506.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32661.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29123.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27218.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32661.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":95835.47},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65323.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28578.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":97868.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29123.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25227.38,"maximum":108009.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26488.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26993.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26993.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":60545.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37529.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25227.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77810.18},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33134.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90988.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108009.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26741.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59788.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":25227.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26993.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25227.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30272.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":93900.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":60545.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26488.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95893.07},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26993.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25354.55,"10th_percentile":25354.55,"90th_percentile":25354.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25946.53,"10th_percentile":25946.53,"90th_percentile":25946.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14171.14,"10th_percentile":14171.14,"90th_percentile":23892.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":73462.56,"10th_percentile":73462.56,"90th_percentile":73462.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":33837.67,"10th_percentile":33837.67,"90th_percentile":33837.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23493.01,"10th_percentile":4339.58,"90th_percentile":25917.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25879.64,"10th_percentile":25879.64,"90th_percentile":25879.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26425.16,"10th_percentile":23618.77,"90th_percentile":43505.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":55727.81,"10th_percentile":55727.81,"90th_percentile":55727.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22627.91,"maximum":82884.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24356.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55671.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22627.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23196.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46914.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49024.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54860.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82884.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24588.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54975.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27835.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23196.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23196.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27835.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":72057.29},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55671.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24356.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73585.97},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24820.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12959.73,"maximum":46904.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31103.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16989.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12959.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35224.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28429.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41190.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46904.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13737.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30714.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15551.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12959.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12959.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15551.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40777.56},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31103.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13607.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41642.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13866.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":33540.97,"10th_percentile":33540.97,"90th_percentile":33540.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":40686.88,"10th_percentile":40686.88,"90th_percentile":40686.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14828.52,"maximum":58639.15,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35588.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19961.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14828.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41386.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28466.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48395.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58639.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15718.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35143.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17794.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14828.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14828.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17794.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50979.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35588.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52060.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22654.95,"10th_percentile":22654.95,"90th_percentile":22654.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":43507.22,"10th_percentile":43507.22,"90th_percentile":43507.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":28625.33,"10th_percentile":28625.33,"90th_percentile":28625.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10896.39,"10th_percentile":10896.39,"90th_percentile":10896.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14140.95,"10th_percentile":14140.95,"90th_percentile":14140.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":32617.39,"10th_percentile":32617.39,"90th_percentile":32617.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14633.04,"10th_percentile":14633.04,"90th_percentile":14633.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24597.75,"maximum":105287.15,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25827.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26319.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26319.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59034.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32672.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24597.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67739.34},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43634.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79211.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105287.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26073.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58296.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29517.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24597.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26319.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24597.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29517.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":91533.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59034.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25827.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93475.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26319.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":67930.94,"10th_percentile":67930.94,"90th_percentile":67930.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1324.48,"10th_percentile":1324.48,"90th_percentile":1324.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26885.82,"10th_percentile":26885.82,"90th_percentile":26885.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24620.28,"10th_percentile":24620.28,"90th_percentile":24620.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":150.0,"10th_percentile":150.0,"90th_percentile":150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15772.24,"maximum":60633.04,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16876.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16876.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25009.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15772.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51851.53},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32401.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60633.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54318.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16718.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37380.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18926.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15772.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16876.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15772.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18926.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47223.2},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16560.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48225.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16876.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12419.77,"10th_percentile":12419.77,"90th_percentile":12419.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10239.73,"10th_percentile":10239.73,"90th_percentile":10239.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23803.91,"maximum":86700.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24994.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25470.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25470.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57129.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34637.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23803.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71814.66},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46894.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83977.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86700.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25232.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56415.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28564.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23803.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25470.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23803.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28564.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":75375.49},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57129.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24994.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":76974.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25470.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9103.81,"maximum":51244.87,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9559.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21849.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21136.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43823.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17057.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51244.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27564.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9650.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21576.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10924.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9741.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9103.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10924.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23963.57},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21849.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9559.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24471.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9741.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13447.36,"maximum":61709.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32273.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25453.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52772.47},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15149.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61709.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52340.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14254.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31870.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13447.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16136.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45503.64},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32273.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14119.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46469.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14388.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11542.94,"10th_percentile":11542.94,"90th_percentile":11542.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":58402.53,"10th_percentile":58402.53,"90th_percentile":58402.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13618.21,"10th_percentile":13618.21,"90th_percentile":13618.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20614.91,"maximum":80856.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21645.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22057.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22057.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32461.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20614.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67303.93},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28441.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78702.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80856.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21851.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48857.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24737.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20614.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22057.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20614.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24737.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":70294.75},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21645.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71786.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22057.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19790.05,"10th_percentile":19790.05,"90th_percentile":19790.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45724.74,"10th_percentile":45724.74,"90th_percentile":45724.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":66130.85,"10th_percentile":66130.85,"90th_percentile":66130.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":29115.69,"10th_percentile":29115.69,"90th_percentile":29115.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82867.71,"10th_percentile":82867.71,"90th_percentile":82867.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17474.88,"10th_percentile":17474.88,"90th_percentile":17474.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19281.8,"10th_percentile":17410.69,"90th_percentile":21675.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14048.3,"maximum":61486.51,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14750.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15031.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15031.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33715.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25361.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52581.39},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27008.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61486.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54062.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14891.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33294.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16857.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14048.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15031.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16857.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47000.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33715.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14750.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47997.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15031.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13244.44,"10th_percentile":13244.44,"90th_percentile":13244.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1334.67,"10th_percentile":1334.67,"90th_percentile":1334.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":56719.39,"10th_percentile":55367.97,"90th_percentile":63290.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23129.08,"10th_percentile":23129.08,"90th_percentile":23129.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13017.95,"10th_percentile":13017.95,"90th_percentile":13017.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12762.54,"10th_percentile":12762.54,"90th_percentile":12762.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":30431.77,"10th_percentile":30431.77,"90th_percentile":30431.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19884.89,"maximum":82548.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20879.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21276.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21276.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47723.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34048.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19884.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70593.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39030.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82548.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78897.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21077.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47127.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23861.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19884.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21276.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19884.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23861.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":68591.32},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47723.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20879.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70046.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21276.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19422.38,"10th_percentile":19422.38,"90th_percentile":19422.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42359.59,"10th_percentile":42359.59,"90th_percentile":42359.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":46023.2,"10th_percentile":34300.26,"90th_percentile":71472.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18514.95,"10th_percentile":18514.95,"90th_percentile":18514.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":81775.2,"10th_percentile":56424.5,"90th_percentile":94829.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":46573.63,"10th_percentile":46573.63,"90th_percentile":46573.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":79589.99,"10th_percentile":79589.99,"90th_percentile":81535.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19618.06,"10th_percentile":17686.87,"90th_percentile":21130.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":713.39,"10th_percentile":713.39,"90th_percentile":713.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18835.42,"10th_percentile":18835.42,"90th_percentile":18835.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18964.96,"10th_percentile":17437.1,"90th_percentile":20646.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":72279.86,"10th_percentile":72279.86,"90th_percentile":72279.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17975.67,"10th_percentile":17975.67,"90th_percentile":17975.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26286.56,"maximum":106010.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27600.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28126.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28126.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63087.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41644.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86342.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46276.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100965.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106010.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27863.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62299.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26286.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28126.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26286.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":92162.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63087.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27600.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94117.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28126.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29935.41,"10th_percentile":29935.41,"90th_percentile":29935.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25494.92,"10th_percentile":25494.92,"90th_percentile":25494.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52052.07,"10th_percentile":52052.07,"90th_percentile":52052.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":40697.69,"10th_percentile":40697.69,"90th_percentile":40697.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26179.24,"10th_percentile":26179.24,"90th_percentile":26179.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":86687.55,"10th_percentile":86687.55,"90th_percentile":88565.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":47692.6,"10th_percentile":47692.6,"90th_percentile":47692.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25308.37,"10th_percentile":23422.01,"90th_percentile":28160.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51868.45,"10th_percentile":51868.45,"90th_percentile":51868.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25813.76,"10th_percentile":24839.78,"90th_percentile":62458.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":52012.46,"10th_percentile":52012.46,"90th_percentile":52012.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24613.46,"10th_percentile":23255.76,"90th_percentile":25047.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26102.22,"10th_percentile":25831.08,"90th_percentile":28332.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11988.76,"maximum":64028.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12588.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12827.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12827.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28773.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26409.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54755.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26252.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64028.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48289.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12708.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28413.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11988.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12827.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11988.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14386.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41981.25},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28773.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12588.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42871.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12827.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21932.27,"10th_percentile":21932.27,"90th_percentile":21932.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12238.56,"10th_percentile":12238.56,"90th_percentile":12238.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":26496.0,"10th_percentile":26496.0,"90th_percentile":26496.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46286.11,"10th_percentile":46286.11,"90th_percentile":46286.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10507.9,"10th_percentile":10507.9,"90th_percentile":10507.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11741.86,"10th_percentile":11741.86,"90th_percentile":11741.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16922.49,"maximum":91097.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17768.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18107.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18107.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40613.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37574.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16922.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77904.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34000.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91097.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71473.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17937.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40106.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16922.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18107.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16922.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20306.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62137.62},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40613.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17768.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63455.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18107.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16351.48,"10th_percentile":16351.48,"90th_percentile":16351.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":33826.57,"10th_percentile":33826.57,"90th_percentile":33826.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16982.77,"10th_percentile":16982.77,"90th_percentile":16982.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33989.07,"maximum":151017.28,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35688.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36368.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36368.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81573.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46946.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33989.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97334.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78949.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113819.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151017.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36028.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80554.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40786.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":33989.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36368.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33989.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40786.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":131290.48},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81573.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35688.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":134075.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36368.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35853.95,"10th_percentile":35853.95,"90th_percentile":35853.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":94449.64,"10th_percentile":94449.64,"90th_percentile":94449.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34366.31,"10th_percentile":34366.31,"90th_percentile":34366.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":130335.3,"10th_percentile":130335.3,"90th_percentile":130335.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14233.32,"maximum":55774.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14944.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34159.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32282.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35572.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32797.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41596.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55774.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33732.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14233.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17079.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48488.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34159.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14944.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49517.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13845.25,"10th_percentile":13845.25,"90th_percentile":13845.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38458.43,"10th_percentile":38458.43,"90th_percentile":38458.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13499.59,"10th_percentile":13499.59,"90th_percentile":13499.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36750.28,"10th_percentile":36750.28,"90th_percentile":36750.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":31977.0,"10th_percentile":31977.0,"90th_percentile":31977.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":43916.44,"10th_percentile":43916.44,"90th_percentile":43916.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13770.06,"10th_percentile":13770.06,"90th_percentile":13770.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13743.07,"10th_percentile":13743.07,"90th_percentile":14903.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16552.46,"maximum":69619.69,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39725.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38500.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59378.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34990.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69435.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69619.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17545.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39229.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19862.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16552.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19862.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60525.54},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39725.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61809.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15523.26,"10th_percentile":15523.26,"90th_percentile":16919.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28864.86,"10th_percentile":28864.86,"90th_percentile":28864.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16541.96,"10th_percentile":16340.35,"90th_percentile":16550.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":57128.74,"10th_percentile":57128.74,"90th_percentile":63487.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16846.45,"10th_percentile":16359.29,"90th_percentile":16919.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16810.02,"10th_percentile":16697.53,"90th_percentile":16898.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16832.4,"10th_percentile":11875.61,"90th_percentile":16899.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10592.05,"10th_percentile":10592.05,"90th_percentile":10592.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24167.49,"maximum":119361.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25375.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25859.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25859.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58001.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49232.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24167.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102074.18},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50630.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119361.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104829.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25617.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57276.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29000.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24167.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25859.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24167.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29000.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":91136.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58001.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25375.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93069.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25859.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24440.66,"10th_percentile":24440.66,"90th_percentile":67518.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25054.31,"10th_percentile":25054.31,"90th_percentile":25054.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23075.97,"10th_percentile":23075.97,"90th_percentile":24581.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":121101.21,"10th_percentile":121101.21,"90th_percentile":121101.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":107010.61,"10th_percentile":107010.61,"90th_percentile":107010.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23936.03,"10th_percentile":20484.36,"90th_percentile":36308.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25268.87,"10th_percentile":25268.87,"90th_percentile":25268.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22782.18,"10th_percentile":22728.39,"90th_percentile":25064.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11199.21,"maximum":90508.18,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11983.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11983.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26878.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37331.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11199.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77399.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15218.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90508.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46660.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11871.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26542.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13439.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11199.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11983.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11199.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13439.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40565.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26878.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11759.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41425.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11983.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21712.81,"maximum":109826.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23232.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23232.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52110.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45299.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21712.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93920.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23844.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109826.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89995.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23015.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51459.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26055.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22798.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79899.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23232.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19083.31,"10th_percentile":19083.31,"90th_percentile":21635.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44189.65,"10th_percentile":43977.17,"90th_percentile":105607.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20969.59,"10th_percentile":16973.51,"90th_percentile":21472.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":76612.37,"10th_percentile":76612.37,"90th_percentile":76612.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23989.32,"10th_percentile":23781.15,"90th_percentile":45472.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92332.5,"10th_percentile":92332.5,"90th_percentile":92332.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19736.82,"10th_percentile":19616.35,"90th_percentile":61269.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46007.51,"10th_percentile":46007.51,"90th_percentile":46007.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20051.03,"10th_percentile":15033.15,"90th_percentile":24972.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20855.99,"10th_percentile":20855.99,"90th_percentile":20855.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36565.66,"maximum":155653.03,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38393.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39125.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39125.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":87757.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59608.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36565.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123587.88},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49248.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144518.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155653.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38759.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":86660.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43878.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":36565.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39125.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36565.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43878.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":135320.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":87757.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38393.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":138191.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39125.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16738.29,"10th_percentile":16738.29,"90th_percentile":16738.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34682.73,"10th_percentile":1538.02,"90th_percentile":38853.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85744.53,"10th_percentile":85744.53,"90th_percentile":85744.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":94339.87,"10th_percentile":94339.87,"90th_percentile":94339.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34858.8,"10th_percentile":34858.8,"90th_percentile":35080.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":57745.92,"10th_percentile":57745.92,"90th_percentile":57745.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35200.21,"10th_percentile":33909.13,"90th_percentile":36029.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":83462.33,"10th_percentile":83462.33,"90th_percentile":83462.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35739.49,"10th_percentile":35739.49,"90th_percentile":35739.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31932.29,"10th_percentile":18454.68,"90th_percentile":54351.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31309.93,"maximum":136654.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32875.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33501.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33501.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75143.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56365.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31309.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116862.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65799.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136654.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127075.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33188.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74204.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37571.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31309.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33501.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31309.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37571.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":110475.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75143.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32875.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":112819.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33501.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30339.54,"10th_percentile":30264.32,"90th_percentile":30344.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":78701.63,"10th_percentile":78701.63,"90th_percentile":156519.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31454.53,"10th_percentile":29174.43,"90th_percentile":33276.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71631.99,"10th_percentile":71272.4,"90th_percentile":72032.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"11","median_amount":56983.62,"10th_percentile":54466.11,"90th_percentile":57904.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29832.11,"10th_percentile":29277.09,"90th_percentile":32423.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"26","median_amount":121372.03,"10th_percentile":117083.82,"90th_percentile":122868.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":68974.32,"10th_percentile":68800.16,"90th_percentile":69368.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":146589.1,"10th_percentile":146589.1,"90th_percentile":146589.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":131728.1,"10th_percentile":131728.1,"90th_percentile":131775.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30046.56,"10th_percentile":26938.74,"90th_percentile":30966.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30514.48,"10th_percentile":30344.64,"90th_percentile":51093.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":103852.24,"10th_percentile":103852.24,"90th_percentile":103852.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30265.0,"10th_percentile":30206.68,"90th_percentile":30622.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":114942.65,"10th_percentile":114942.65,"90th_percentile":114942.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43356.0,"maximum":188206.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45523.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":104054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":77628.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43356.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160948.67},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81055.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188206.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181838.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":102753.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52027.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":43356.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46390.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43356.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52027.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":158085.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":104054.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45523.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":161439.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46390.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43562.26,"10th_percentile":43562.26,"90th_percentile":43562.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":79345.37,"10th_percentile":79345.37,"90th_percentile":79345.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":169615.7,"10th_percentile":167348.88,"90th_percentile":184445.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":84152.69,"10th_percentile":84152.69,"90th_percentile":84152.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":186475.23,"10th_percentile":186475.23,"90th_percentile":186475.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43522.17,"10th_percentile":43522.17,"90th_percentile":51434.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42681.36,"10th_percentile":42681.36,"90th_percentile":120977.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":64115.44,"10th_percentile":64115.44,"90th_percentile":64115.44},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45528.69,"10th_percentile":43498.57,"90th_percentile":75831.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40445.24,"maximum":180276.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42467.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43276.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43276.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97068.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74357.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40445.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154166.91},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77813.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":180276.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164411.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42871.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":95855.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48534.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":40445.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43276.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40445.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48534.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":142935.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97068.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42467.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":145967.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43276.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29253.14,"10th_percentile":29253.14,"90th_percentile":37233.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":217741.71,"10th_percentile":217741.71,"90th_percentile":217741.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39844.29,"10th_percentile":39844.29,"90th_percentile":39844.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":78740.86,"10th_percentile":78740.86,"90th_percentile":78740.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40364.25,"10th_percentile":37510.05,"90th_percentile":41489.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":155424.15,"10th_percentile":148500.01,"90th_percentile":158804.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":79683.1,"10th_percentile":79683.1,"90th_percentile":79683.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":162000.64,"10th_percentile":162000.64,"90th_percentile":162000.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":38623.31,"10th_percentile":33395.16,"90th_percentile":42520.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":144905.86,"10th_percentile":144905.86,"90th_percentile":147803.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31665.08,"10th_percentile":29229.94,"90th_percentile":42686.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":146386.08,"10th_percentile":146386.08,"90th_percentile":146386.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56096.23,"maximum":241547.3,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58901.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60022.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60022.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":134630.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97443.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56096.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":202030.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98401.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":236246.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":241547.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":132948.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67315.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":56096.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60022.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56096.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67315.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":209994.91},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":134630.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58901.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":214449.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60022.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55032.8,"10th_percentile":55032.8,"90th_percentile":55032.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58725.82,"10th_percentile":58725.82,"90th_percentile":58725.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":98845.06,"10th_percentile":98845.06,"90th_percentile":98845.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48500.29,"10th_percentile":48500.29,"90th_percentile":48500.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":206668.78,"10th_percentile":205285.97,"90th_percentile":247246.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":101458.19,"10th_percentile":101458.19,"90th_percentile":101894.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":244345.19,"10th_percentile":244345.19,"90th_percentile":244345.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54604.09,"10th_percentile":54375.47,"90th_percentile":62657.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55638.75,"10th_percentile":51466.59,"90th_percentile":73198.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":80258.25,"10th_percentile":80258.25,"90th_percentile":80258.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":218915.96,"10th_percentile":218915.96,"90th_percentile":218915.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57800.51,"10th_percentile":57800.51,"90th_percentile":74901.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55752.59,"10th_percentile":55752.59,"90th_percentile":55752.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44747.2,"maximum":226909.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46984.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47879.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47879.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":107393.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":93592.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44747.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194046.19},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90066.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":226909.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188777.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47432.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":106050.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53696.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":44747.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47879.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44747.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53696.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":164117.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":107393.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46984.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":167599.54},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47879.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45069.83,"10th_percentile":45069.83,"90th_percentile":45069.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41759.57,"10th_percentile":41759.57,"90th_percentile":41759.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61723.42,"maximum":267370.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64809.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66044.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66044.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":148136.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":110281.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":228647.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136456.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":267370.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":261870.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65426.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":146284.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":61723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66044.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":227663.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":148136.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64809.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":232493.15},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66044.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":233816.1,"10th_percentile":233816.1,"90th_percentile":233816.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23856.98,"maximum":194836.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25049.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25526.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25526.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57256.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80363.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23856.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166618.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48891.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":194836.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95994.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25288.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28628.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23856.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25526.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23856.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28628.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":83454.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57256.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25049.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85225.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25526.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1274.28,"10th_percentile":1274.28,"90th_percentile":1274.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":170745.46,"10th_percentile":170745.46,"90th_percentile":170745.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23170.23,"10th_percentile":23170.23,"90th_percentile":25098.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22270.87,"10th_percentile":22270.87,"90th_percentile":22270.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23638.94,"10th_percentile":23638.94,"90th_percentile":23638.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36749.95,"maximum":246883.77,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38587.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":88199.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101830.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36749.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211127.47},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67346.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":246883.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":153996.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38954.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":87097.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44099.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":36749.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36749.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44099.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":133880.56},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":88199.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38587.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":136720.81},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39322.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":75418.33,"10th_percentile":75418.33,"90th_percentile":75418.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52053.67,"10th_percentile":52053.67,"90th_percentile":52053.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36623.76,"10th_percentile":36623.76,"90th_percentile":36623.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41081.13,"10th_percentile":41081.13,"90th_percentile":41081.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37415.43,"maximum":192170.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40034.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40034.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":89797.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":79263.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37415.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164337.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68335.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":192170.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":141925.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39660.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":88674.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44898.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":37415.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40034.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37415.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44898.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":123385.92},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":89797.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":126003.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40034.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32947.37,"10th_percentile":32947.37,"90th_percentile":32947.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32925.06,"10th_percentile":32925.06,"90th_percentile":32925.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":4329.73,"10th_percentile":4329.73,"90th_percentile":4329.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":72047.61,"10th_percentile":72047.61,"90th_percentile":72047.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":196102.09,"10th_percentile":196102.09,"90th_percentile":196102.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34245.82,"10th_percentile":34245.82,"90th_percentile":34245.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34065.95,"10th_percentile":34065.95,"90th_percentile":34065.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39513.71,"maximum":209807.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41489.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42279.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42279.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":94832.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":86538.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39513.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179420.76},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85425.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":209807.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":163682.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41884.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":93647.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":39513.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42279.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39513.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47416.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":142300.99},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":94832.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41489.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":145319.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42279.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40359.23,"10th_percentile":40359.23,"90th_percentile":40359.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40419.47,"10th_percentile":40419.47,"90th_percentile":40419.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":90049.53,"10th_percentile":90049.53,"90th_percentile":90049.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39701.72,"10th_percentile":39701.72,"90th_percentile":39701.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":185095.1,"10th_percentile":184212.84,"90th_percentile":196363.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":89142.39,"10th_percentile":88084.72,"90th_percentile":90003.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39151.79,"10th_percentile":37552.51,"90th_percentile":39350.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38547.04,"10th_percentile":38547.04,"90th_percentile":38547.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":147668.29,"10th_percentile":147668.29,"90th_percentile":147668.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48130.49,"10th_percentile":48130.49,"90th_percentile":48130.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37917.72,"10th_percentile":37917.72,"90th_percentile":37917.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":56333.59,"maximum":263997.14,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59150.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60276.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60276.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":135200.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":108889.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225762.3},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103051.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":263997.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":239111.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59713.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":133510.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67600.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":56333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60276.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56333.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67600.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":207877.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":135200.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59150.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":212287.81},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60276.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54358.33,"10th_percentile":54358.33,"90th_percentile":54358.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58488.96,"10th_percentile":58488.96,"90th_percentile":58488.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":120922.19,"10th_percentile":120922.19,"90th_percentile":120922.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":110877.59,"10th_percentile":110877.59,"90th_percentile":110877.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":170952.48,"10th_percentile":170952.48,"90th_percentile":170952.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":231119.47,"10th_percentile":231119.47,"90th_percentile":231541.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":47819.93,"10th_percentile":47819.93,"90th_percentile":47819.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54562.24,"10th_percentile":48380.49,"90th_percentile":60885.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61118.14,"10th_percentile":61118.14,"90th_percentile":61118.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":212731.94,"10th_percentile":212731.94,"90th_percentile":212731.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56153.32,"10th_percentile":55312.63,"90th_percentile":70773.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58357.98,"10th_percentile":58357.98,"90th_percentile":58357.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48423.84,"maximum":251261.02,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50845.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":116217.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":103636.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48423.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214870.75},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98864.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":251261.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183856.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":114764.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58108.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":48423.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48423.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58108.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":159840.42},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":116217.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50845.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":163231.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48423.84,"maximum":277700.29,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50845.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":116217.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":114541.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48423.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237480.81},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93073.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":277700.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199565.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51329.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":114764.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58108.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":48423.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48423.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58108.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":173497.42},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":116217.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50845.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":177178.14},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51813.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":241861.91,"10th_percentile":241861.91,"90th_percentile":241861.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45002.71,"10th_percentile":45002.71,"90th_percentile":45002.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":71425.24,"maximum":340802.17,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74996.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76425.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76425.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":171420.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":140568.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71425.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71213.03,"10th_percentile":71213.03,"90th_percentile":71514.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":297263.79,"10th_percentile":297263.79,"90th_percentile":297263.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":75019.57,"10th_percentile":75019.57,"90th_percentile":75019.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":73722.27,"10th_percentile":73722.27,"90th_percentile":87154.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":158542.48,"10th_percentile":158542.48,"90th_percentile":158542.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":72674.45,"maximum":327413.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77761.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77761.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":174418.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":181325.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72674.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":250646.52},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138538.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":293095.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":327413.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77034.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":172238.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87209.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":72674.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77761.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":72674.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87209.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":284644.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":174418.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":290683.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77761.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72213.62,"10th_percentile":72213.62,"90th_percentile":72213.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":174838.43,"10th_percentile":174838.43,"90th_percentile":174838.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":174541.34,"10th_percentile":174541.34,"90th_percentile":174541.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":71846.29,"10th_percentile":71846.29,"90th_percentile":71846.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":143477.98,"10th_percentile":143477.98,"90th_percentile":143477.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":75524.83,"10th_percentile":75524.83,"90th_percentile":86582.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74514.83,"10th_percentile":74514.83,"90th_percentile":74514.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79251.1,"maximum":336651.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83213.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84798.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84798.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":190202.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":119438.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79251.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":247633.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186166.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":289571.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":336651.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84006.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":187825.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95101.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":79251.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84798.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79251.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":95101.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":292675.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":190202.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83213.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":298884.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":84798.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20982.79,"maximum":82952.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22031.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22451.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22451.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50358.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33938.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20982.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70364.34},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29296.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82281.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82952.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22241.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49729.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20982.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22451.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20982.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25179.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":72116.4},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50358.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22031.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73646.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22451.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19587.88,"10th_percentile":17994.34,"90th_percentile":21576.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":171.73,"10th_percentile":171.73,"90th_percentile":171.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":35395.14,"10th_percentile":35395.14,"90th_percentile":35395.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19759.46,"10th_percentile":17965.8,"90th_percentile":20256.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46080.56,"10th_percentile":38768.28,"90th_percentile":83566.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":34252.51,"10th_percentile":34144.97,"90th_percentile":45325.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19310.36,"10th_percentile":18445.4,"90th_percentile":21148.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":67815.19,"10th_percentile":67815.19,"90th_percentile":73979.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":31050.32,"10th_percentile":29711.53,"90th_percentile":92213.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":82679.48,"10th_percentile":82679.48,"90th_percentile":82679.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29165.02,"10th_percentile":15828.3,"90th_percentile":33586.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":18628.24,"10th_percentile":17917.82,"90th_percentile":21051.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19214.41,"10th_percentile":19214.41,"90th_percentile":19214.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":20054.79,"10th_percentile":19583.14,"90th_percentile":21606.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18806.25,"10th_percentile":18806.25,"90th_percentile":18806.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17515.76,"10th_percentile":10019.39,"90th_percentile":17919.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":72473.69,"10th_percentile":72473.69,"90th_percentile":99171.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":19865.02,"10th_percentile":17735.67,"90th_percentile":21578.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":165184.29,"10th_percentile":165184.29,"90th_percentile":165184.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19431.63,"10th_percentile":18816.22,"90th_percentile":22214.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47415.58,"maximum":199884.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49786.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50734.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50734.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":113797.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":77402.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47415.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160478.8},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80823.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187657.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":199884.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50260.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":112374.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56898.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":47415.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50734.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47415.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56898.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":173774.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":113797.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49786.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":177460.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50734.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45518.47,"10th_percentile":45518.47,"90th_percentile":45518.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":48538.85,"10th_percentile":48538.85,"90th_percentile":48538.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45027.09,"10th_percentile":45027.09,"90th_percentile":45027.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":109262.1,"10th_percentile":109262.1,"90th_percentile":109262.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":118665.77,"10th_percentile":118665.77,"90th_percentile":118665.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31991.03,"10th_percentile":31991.03,"90th_percentile":31991.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":181254.1,"10th_percentile":181254.1,"90th_percentile":181254.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":81207.65,"10th_percentile":81207.65,"90th_percentile":81207.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":43807.22,"10th_percentile":43807.22,"90th_percentile":43807.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":116910.05,"10th_percentile":116910.05,"90th_percentile":116910.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30659.45,"10th_percentile":30659.45,"90th_percentile":30659.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50852.09,"10th_percentile":50852.09,"90th_percentile":50852.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1992.16,"10th_percentile":1992.16,"90th_percentile":1992.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":47680.73,"10th_percentile":47680.73,"90th_percentile":47680.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47050.69,"10th_percentile":45642.87,"90th_percentile":48584.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8020.25,"maximum":28746.94,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19248.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11857.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24583.51},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11214.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28746.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27993.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8501.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19007.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9624.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8020.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8020.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9624.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24337.03},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19248.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8421.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24853.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8581.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8196.79,"10th_percentile":8196.79,"90th_percentile":8196.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7100.91,"10th_percentile":7100.91,"90th_percentile":7100.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":3574.13,"10th_percentile":3574.13,"90th_percentile":3574.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14401.84,"maximum":58339.37,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15121.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15409.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15409.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16069.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14401.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33316.79},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16021.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38959.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58339.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15265.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34132.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17282.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14401.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15409.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14401.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17282.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50718.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34564.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15121.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51794.71},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15409.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12438.1,"10th_percentile":12438.1,"90th_percentile":12438.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14651.97,"10th_percentile":14651.97,"90th_percentile":14651.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30778.69,"10th_percentile":30778.69,"90th_percentile":30778.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14119.43,"10th_percentile":14119.43,"90th_percentile":14119.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12665.43,"10th_percentile":12665.43,"90th_percentile":12665.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14387.51,"10th_percentile":14387.51,"90th_percentile":14387.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6562.88,"maximum":25060.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7555.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7555.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16947.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10059.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20855.89},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6562.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24388.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25060.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7485.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16735.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7061.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7555.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21787.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16947.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7414.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22249.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7555.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6403.96,"10th_percentile":6403.96,"90th_percentile":6403.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4947.15,"maximum":22900.85,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14582.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9445.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6076.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19584.11},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4947.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22900.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21519.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6440.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14400.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7291.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6076.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6076.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7291.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18708.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14582.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6379.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19105.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9468.21,"10th_percentile":9468.21,"90th_percentile":9468.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":18659.35,"10th_percentile":18659.35,"90th_percentile":18659.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8118.4,"maximum":29875.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19766.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11846.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8236.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24561.58},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8118.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28721.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29875.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19519.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8236.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8236.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9883.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25973.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19766.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26524.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12886.14,"10th_percentile":12886.14,"90th_percentile":12886.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3658.52,"10th_percentile":3658.52,"90th_percentile":3658.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":11726.38,"10th_percentile":11726.38,"90th_percentile":11726.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11974.56,"10th_percentile":11974.56,"90th_percentile":18578.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11425.75,"10th_percentile":3547.77,"90th_percentile":14558.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23432.06,"10th_percentile":19077.45,"90th_percentile":31144.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8318.24,"10th_percentile":7376.33,"90th_percentile":11024.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7139.0,"10th_percentile":7139.0,"90th_percentile":7139.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8720.72,"10th_percentile":8720.72,"90th_percentile":8757.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13952.78,"10th_percentile":13952.78,"90th_percentile":15071.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7798.85,"10th_percentile":7798.85,"90th_percentile":7820.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7893.79,"10th_percentile":7893.79,"90th_percentile":7893.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":24040.46,"10th_percentile":24040.46,"90th_percentile":24040.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7732.98,"10th_percentile":7732.98,"90th_percentile":7843.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":26338.65,"10th_percentile":26338.65,"90th_percentile":26338.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6399.58,"maximum":31457.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6719.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6847.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6847.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15358.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12975.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6399.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26901.52},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6579.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31457.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20919.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15167.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6399.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6847.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6399.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7679.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18186.95},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15358.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6719.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18572.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6847.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11527.57,"10th_percentile":11527.57,"90th_percentile":13189.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7031.33,"10th_percentile":7031.33,"90th_percentile":7031.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5947.62,"10th_percentile":5947.62,"90th_percentile":5947.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4758.59,"10th_percentile":4758.59,"90th_percentile":4758.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5090.96,"10th_percentile":5090.96,"90th_percentile":5090.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9154.72,"maximum":39387.85,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9612.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9795.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9795.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21971.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16246.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9154.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33683.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12687.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39387.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34224.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9704.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21696.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10985.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9154.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9795.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9154.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10985.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29753.62},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21971.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9612.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30384.84},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9795.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7435.46,"10th_percentile":7435.46,"90th_percentile":7435.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":1779.47,"10th_percentile":1779.47,"90th_percentile":1779.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8653.0,"10th_percentile":8653.0,"90th_percentile":8653.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":15142.97,"10th_percentile":14809.08,"90th_percentile":26333.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12687.15,"10th_percentile":12687.15,"90th_percentile":12687.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8875.47,"10th_percentile":8638.9,"90th_percentile":8959.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8404.64,"10th_percentile":8404.64,"90th_percentile":8404.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":27241.97,"10th_percentile":27241.97,"90th_percentile":27241.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13922.09,"maximum":54553.51,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14618.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33413.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22207.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13922.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46043.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17059.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53841.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54553.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14757.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32995.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16706.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13922.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13922.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16706.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47427.39},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33413.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14618.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48433.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14896.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13313.76,"10th_percentile":13313.76,"90th_percentile":13313.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":82520.78,"10th_percentile":82520.78,"90th_percentile":82520.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31111.03,"10th_percentile":31111.03,"90th_percentile":31111.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":22119.82,"10th_percentile":22119.82,"90th_percentile":22119.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13014.14,"10th_percentile":13014.14,"90th_percentile":13723.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":46460.06,"10th_percentile":46460.06,"90th_percentile":46460.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16953.83,"10th_percentile":16953.83,"90th_percentile":17219.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11874.71,"10th_percentile":11818.92,"90th_percentile":14219.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15042.31,"10th_percentile":15042.31,"90th_percentile":15042.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13336.97,"10th_percentile":12435.52,"90th_percentile":13442.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6407.46,"maximum":35362.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6855.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6855.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15377.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14585.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30240.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13337.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35362.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21645.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6791.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15185.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7688.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6407.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6855.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6407.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7688.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18818.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15377.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6727.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19217.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6855.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8077.62,"maximum":41970.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19386.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17311.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8077.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35891.67},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13269.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41970.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30592.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8562.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19143.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9693.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8077.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8077.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9693.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26596.63},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19386.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8481.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27160.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":25646.52,"10th_percentile":25646.52,"90th_percentile":25646.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23064.82,"10th_percentile":23064.82,"90th_percentile":23064.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14804.86,"maximum":58231.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35531.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20820.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14804.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43168.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15446.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50479.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58231.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15693.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35087.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17765.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14804.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14804.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17765.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50624.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35531.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51698.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32692.48,"10th_percentile":32692.48,"90th_percentile":32692.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16194.77,"10th_percentile":16194.77,"90th_percentile":16194.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17851.79,"10th_percentile":17851.79,"90th_percentile":17851.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14243.97,"10th_percentile":14243.97,"90th_percentile":14243.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29664.84,"10th_percentile":29664.84,"90th_percentile":29664.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14081.75,"10th_percentile":13539.23,"90th_percentile":14200.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5778.56,"maximum":23809.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6067.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13868.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9820.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20360.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6337.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23809.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19247.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6125.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13695.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6934.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16733.39},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13868.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6067.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17088.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6183.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5403.41,"10th_percentile":5403.41,"90th_percentile":5403.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":9896.6,"10th_percentile":9896.6,"90th_percentile":9896.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10017.3,"10th_percentile":10017.3,"90th_percentile":10017.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1172.36,"10th_percentile":1172.36,"90th_percentile":1172.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":19660.96,"10th_percentile":11073.78,"90th_percentile":24011.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6020.08,"10th_percentile":6020.08,"90th_percentile":6020.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8227.78,"10th_percentile":8227.78,"90th_percentile":8227.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5179.88,"10th_percentile":5179.88,"90th_percentile":5179.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":15322.25,"10th_percentile":15322.25,"90th_percentile":15322.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3839.21,"10th_percentile":3839.21,"90th_percentile":3839.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7050.71,"maximum":25342.1,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7403.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7544.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7544.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16921.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9820.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7050.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20360.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9327.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23809.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25342.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7473.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16710.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7050.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7544.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7050.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8460.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22031.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16921.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7403.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22499.16},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7544.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4807.57,"10th_percentile":376.95,"90th_percentile":6920.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":23822.18,"10th_percentile":23822.18,"90th_percentile":23822.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6509.65,"10th_percentile":6509.65,"90th_percentile":6509.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16154.24,"10th_percentile":16154.24,"90th_percentile":16154.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10017.3,"10th_percentile":10017.3,"90th_percentile":10017.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6599.08,"10th_percentile":6599.08,"90th_percentile":6656.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":12185.78,"10th_percentile":12185.78,"90th_percentile":31308.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":7636.17,"10th_percentile":7623.75,"90th_percentile":9527.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":17350.48,"10th_percentile":17350.48,"90th_percentile":17350.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15745.73,"10th_percentile":15745.73,"90th_percentile":15745.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25595.86,"10th_percentile":25595.86,"90th_percentile":25595.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":163.93,"10th_percentile":163.93,"90th_percentile":163.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":6042.44,"10th_percentile":373.08,"90th_percentile":7399.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11045.19,"10th_percentile":11045.19,"90th_percentile":11045.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10312.71,"10th_percentile":10312.71,"90th_percentile":10312.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6848.66,"10th_percentile":6728.23,"90th_percentile":7337.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":10289.69,"10th_percentile":10289.69,"90th_percentile":10289.69},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":6624.12,"10th_percentile":5660.82,"90th_percentile":6921.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":373.08,"10th_percentile":373.08,"90th_percentile":373.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10697.23,"maximum":40726.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11232.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11331.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10697.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23493.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14193.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27472.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40726.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11339.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25352.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12836.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10697.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10697.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12836.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35406.65},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25673.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11232.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36157.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11446.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":9744.75,"10th_percentile":6123.39,"90th_percentile":10306.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10169.52,"10th_percentile":10169.52,"90th_percentile":17839.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":9708.65,"10th_percentile":9708.65,"90th_percentile":13228.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":9098.54,"10th_percentile":5304.78,"90th_percentile":11411.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22215.69,"10th_percentile":14969.71,"90th_percentile":26413.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"20","median_amount":10991.5,"10th_percentile":6728.44,"90th_percentile":11602.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":9951.83,"10th_percentile":8598.35,"90th_percentile":10878.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"31","median_amount":22320.93,"10th_percentile":10148.15,"90th_percentile":26136.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"11","median_amount":11809.89,"10th_percentile":11421.63,"90th_percentile":14068.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":24851.0,"10th_percentile":24851.0,"90th_percentile":24851.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9482.56,"10th_percentile":9482.56,"90th_percentile":9482.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22081.32,"10th_percentile":22081.32,"90th_percentile":22081.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"59","median_amount":9222.58,"10th_percentile":5972.78,"90th_percentile":10543.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18777.84,"10th_percentile":18725.86,"90th_percentile":20831.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10245.63,"10th_percentile":10245.63,"90th_percentile":17655.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10598.13,"10th_percentile":10598.13,"90th_percentile":10598.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10272.59,"10th_percentile":10137.57,"90th_percentile":11489.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10276.49,"10th_percentile":10276.49,"90th_percentile":10328.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11478.24,"10th_percentile":10554.41,"90th_percentile":11863.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9932.69,"10th_percentile":9932.69,"90th_percentile":17284.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":33604.53,"10th_percentile":19643.33,"90th_percentile":35769.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"63","median_amount":10116.31,"10th_percentile":6811.54,"90th_percentile":11117.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":34134.16,"10th_percentile":34134.16,"90th_percentile":34134.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5902.32,"10th_percentile":514.17,"90th_percentile":10496.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5875.37,"maximum":29834.84,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6169.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6286.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6286.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14100.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12305.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25513.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7236.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29834.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20001.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13924.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7050.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5875.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6286.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5875.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7050.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17388.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14100.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6169.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17757.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6286.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":375.87,"10th_percentile":375.87,"90th_percentile":375.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5502.94,"10th_percentile":5502.94,"90th_percentile":5502.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":339.13,"10th_percentile":339.13,"90th_percentile":339.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5672.03,"10th_percentile":5672.03,"90th_percentile":5672.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4403.06,"10th_percentile":4403.06,"90th_percentile":4403.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7316.76,"maximum":34450.18,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7682.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7828.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7828.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17560.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14209.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29460.74},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9426.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34450.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26550.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7755.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17340.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7828.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7316.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8780.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23082.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17560.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7682.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23571.99},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7828.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7061.6,"10th_percentile":7061.6,"90th_percentile":7061.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5585.89,"10th_percentile":382.66,"90th_percentile":5805.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13417.6,"10th_percentile":13417.6,"90th_percentile":13417.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6107.5,"10th_percentile":6107.5,"90th_percentile":6153.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9626.52,"10th_percentile":9626.52,"90th_percentile":9626.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3411.2,"10th_percentile":382.66,"90th_percentile":7973.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7043.86,"10th_percentile":7043.86,"90th_percentile":7709.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8969.32,"10th_percentile":8969.32,"90th_percentile":8969.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7027.09,"10th_percentile":650.21,"90th_percentile":7061.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":310.55,"10th_percentile":310.55,"90th_percentile":310.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6536.49,"10th_percentile":6536.49,"90th_percentile":6536.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9214.96,"maximum":40798.09,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9675.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9860.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9860.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22115.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16827.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34889.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11124.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40798.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34715.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9767.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11057.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9214.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9860.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9214.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11057.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30180.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22115.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9675.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30821.11},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9860.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":763.05,"10th_percentile":693.53,"90th_percentile":8894.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17393.0,"10th_percentile":17393.0,"90th_percentile":17393.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":8074.55,"10th_percentile":484.09,"90th_percentile":9230.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21005.45,"10th_percentile":16676.66,"90th_percentile":21589.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":17373.92,"10th_percentile":17079.66,"90th_percentile":46820.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8498.76,"10th_percentile":7771.85,"90th_percentile":9393.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":19401.02,"10th_percentile":14480.12,"90th_percentile":25084.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9545.69,"10th_percentile":9059.15,"90th_percentile":11367.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"30","median_amount":7478.23,"10th_percentile":859.0,"90th_percentile":9394.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9334.09,"10th_percentile":7109.8,"90th_percentile":25773.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9262.0,"10th_percentile":9262.0,"90th_percentile":9262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8916.64,"10th_percentile":8875.82,"90th_percentile":9612.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8508.12,"10th_percentile":8508.12,"90th_percentile":9212.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9657.25,"10th_percentile":9657.25,"90th_percentile":9657.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9265.26,"10th_percentile":9103.16,"90th_percentile":9267.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":30538.11,"10th_percentile":30538.11,"90th_percentile":30538.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"38","median_amount":7072.96,"10th_percentile":871.23,"90th_percentile":9181.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17751.43,"10th_percentile":17751.43,"90th_percentile":17751.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5827.37,"10th_percentile":5827.37,"90th_percentile":5827.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10130.72,"maximum":50036.09,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10637.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24313.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20638.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42789.34},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13095.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50036.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38244.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10738.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24009.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12156.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10130.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10130.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12156.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33249.15},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24313.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10637.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33954.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10839.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":7956.75,"10th_percentile":606.97,"90th_percentile":9680.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11753.77,"10th_percentile":7943.72,"90th_percentile":18223.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":24065.49,"10th_percentile":24065.49,"90th_percentile":24065.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"42","median_amount":7956.76,"10th_percentile":493.56,"90th_percentile":10110.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":17959.24,"10th_percentile":14365.81,"90th_percentile":22073.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"22","median_amount":19449.16,"10th_percentile":11942.52,"90th_percentile":20834.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":8999.18,"10th_percentile":6134.98,"90th_percentile":9819.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"36","median_amount":33836.42,"10th_percentile":18391.68,"90th_percentile":46475.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"24","median_amount":11297.57,"10th_percentile":10364.03,"90th_percentile":13339.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":17021.03,"10th_percentile":17021.03,"90th_percentile":17021.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9981.66,"10th_percentile":2014.9,"90th_percentile":10273.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34483.94,"10th_percentile":11995.53,"90th_percentile":38596.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7524.0,"10th_percentile":2010.06,"90th_percentile":17231.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"83","median_amount":8481.0,"10th_percentile":493.56,"90th_percentile":9843.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17872.62,"10th_percentile":17528.19,"90th_percentile":20536.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8412.43,"10th_percentile":6920.73,"90th_percentile":11308.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9199.9,"10th_percentile":9199.9,"90th_percentile":9199.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"38","median_amount":9749.33,"10th_percentile":9546.91,"90th_percentile":10494.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10800.16,"10th_percentile":10800.16,"90th_percentile":10800.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9453.79,"10th_percentile":9289.01,"90th_percentile":10111.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11115.26,"10th_percentile":11115.26,"90th_percentile":13295.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"14","median_amount":10965.89,"10th_percentile":7582.65,"90th_percentile":10994.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":30177.09,"10th_percentile":19597.24,"90th_percentile":33609.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16445.63,"10th_percentile":16445.63,"90th_percentile":16445.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"99","median_amount":8769.77,"10th_percentile":1399.38,"90th_percentile":9716.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":22166.4,"10th_percentile":22166.4,"90th_percentile":22166.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9904.66,"10th_percentile":7859.06,"90th_percentile":10796.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6414.64,"maximum":35695.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15395.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14723.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6414.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30525.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12800.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35695.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22687.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6799.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15202.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6414.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6414.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7697.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19723.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15395.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20142.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":358.7,"10th_percentile":358.7,"90th_percentile":358.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8364.47,"maximum":43761.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8782.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20074.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18050.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8364.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37423.44},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10991.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43761.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31025.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8866.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19823.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8364.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8364.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10037.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26972.79},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20074.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8782.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27545.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8949.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11191.72,"10th_percentile":11191.72,"90th_percentile":12557.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8168.18,"10th_percentile":8168.18,"90th_percentile":8168.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7818.32,"10th_percentile":7818.32,"90th_percentile":7818.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12447.71,"maximum":53266.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13070.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29874.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21970.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45552.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16713.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53266.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48829.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13194.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29501.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14937.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12447.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14937.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42451.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29874.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13070.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43352.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13319.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9803.85,"10th_percentile":9803.85,"90th_percentile":9803.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":176746.5,"10th_percentile":176746.5,"90th_percentile":176746.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11884.72,"10th_percentile":11884.72,"90th_percentile":11884.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":46927.21,"10th_percentile":46927.21,"90th_percentile":46927.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16912.87,"10th_percentile":16912.87,"90th_percentile":16912.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12072.59,"10th_percentile":12072.59,"90th_percentile":12072.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12141.29,"10th_percentile":12092.99,"90th_percentile":12867.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6911.59,"maximum":26732.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7257.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16587.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11026.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6911.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22860.66},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12353.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26732.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24031.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7326.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16380.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6911.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6911.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20892.56},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16587.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7257.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21335.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6563.65,"10th_percentile":6563.65,"90th_percentile":6563.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5413.78,"10th_percentile":5413.78,"90th_percentile":5413.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":371.9,"10th_percentile":371.9,"90th_percentile":371.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8902.3,"maximum":35204.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9525.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9525.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21365.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14520.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8902.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30106.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17162.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35204.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33006.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9436.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21098.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10682.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8902.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9525.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8902.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10682.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28695.02},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21365.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9347.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29303.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9525.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":481.9,"10th_percentile":481.9,"90th_percentile":481.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8948.62,"10th_percentile":8948.62,"90th_percentile":8948.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19856.46,"10th_percentile":19856.46,"90th_percentile":19856.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":27486.98,"10th_percentile":27486.98,"90th_percentile":33721.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27324.64,"10th_percentile":27324.64,"90th_percentile":27324.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2566.92,"10th_percentile":2566.92,"90th_percentile":2566.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8731.75,"10th_percentile":8731.75,"90th_percentile":8731.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6794.55,"10th_percentile":6794.55,"90th_percentile":6794.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12242.61,"maximum":49052.42,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12854.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13099.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13099.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29382.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19133.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39669.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15634.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46387.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49052.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29014.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14691.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12242.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13099.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12242.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14691.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42644.89},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29382.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12854.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43549.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13099.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10834.06,"10th_percentile":10834.06,"90th_percentile":10834.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13220.36,"10th_percentile":13220.36,"90th_percentile":13220.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19285.14,"10th_percentile":19285.14,"90th_percentile":19285.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11772.7,"10th_percentile":11772.7,"90th_percentile":11772.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11830.38,"10th_percentile":11830.38,"90th_percentile":11830.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12164.78,"10th_percentile":12164.78,"90th_percentile":12164.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6677.1,"maximum":41959.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7010.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7144.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7144.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16025.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17306.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35882.27},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13072.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41959.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25882.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7077.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15824.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8012.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6677.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7144.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6677.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8012.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22501.95},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16025.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7010.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22979.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7144.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8951.78,"maximum":48080.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9578.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9578.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21484.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19831.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41116.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9992.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48080.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34310.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21215.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8951.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9578.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10742.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29828.85},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21484.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9399.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30461.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9578.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":2300.55,"10th_percentile":2300.55,"90th_percentile":2300.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9286.3,"10th_percentile":9286.3,"90th_percentile":9286.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11961.09,"10th_percentile":11961.09,"90th_percentile":11961.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8632.28,"10th_percentile":8632.28,"90th_percentile":8632.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8785.73,"10th_percentile":8785.73,"90th_percentile":8785.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8721.77,"10th_percentile":8721.77,"90th_percentile":8721.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13935.72,"maximum":56959.09,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14632.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33445.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23493.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13935.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48709.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18253.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56959.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54012.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14771.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33027.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16722.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13935.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13935.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16722.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46957.2},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33445.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14632.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47953.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14911.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11641.42,"10th_percentile":11641.42,"90th_percentile":11641.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":600.51,"10th_percentile":600.51,"90th_percentile":13532.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36076.67,"10th_percentile":36076.67,"90th_percentile":36076.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23690.43,"10th_percentile":23690.43,"90th_percentile":23690.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14123.19,"10th_percentile":14123.19,"90th_percentile":14123.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":55666.76,"10th_percentile":49054.24,"90th_percentile":65478.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13028.6,"10th_percentile":11085.44,"90th_percentile":14866.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12371.5,"10th_percentile":12371.5,"90th_percentile":12371.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13433.86,"10th_percentile":13048.94,"90th_percentile":15032.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18211.04,"10th_percentile":18211.04,"90th_percentile":18211.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":29915.34,"10th_percentile":29915.34,"90th_percentile":30041.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13090.5,"10th_percentile":827.38,"90th_percentile":14421.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12876.25,"10th_percentile":12876.25,"90th_percentile":12876.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6685.7,"maximum":46717.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7019.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16045.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19269.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6685.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39951.33},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7007.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46717.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23787.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7086.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15845.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6685.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6685.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8022.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20680.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16045.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7019.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21119.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7153.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6395.9,"10th_percentile":6395.9,"90th_percentile":6395.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":39230.79,"10th_percentile":39230.79,"90th_percentile":39230.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":6901.9,"10th_percentile":6901.9,"90th_percentile":6901.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5882.22,"10th_percentile":5882.22,"90th_percentile":5882.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8270.52,"maximum":57274.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19849.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23623.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8270.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48979.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9756.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57274.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30660.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8766.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19601.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9924.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8270.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8270.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9924.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26655.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19849.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8684.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27221.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8849.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":584.15,"10th_percentile":584.15,"90th_percentile":584.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":24901.86,"10th_percentile":24901.86,"90th_percentile":24901.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18759.75,"10th_percentile":18759.75,"90th_percentile":18759.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45163.84,"10th_percentile":45163.84,"90th_percentile":45163.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22869.69,"10th_percentile":22869.69,"90th_percentile":22869.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5117.01,"10th_percentile":426.05,"90th_percentile":8181.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1887.54,"10th_percentile":1887.54,"90th_percentile":1887.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8304.6,"10th_percentile":8304.6,"90th_percentile":8368.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6723.36,"10th_percentile":6318.49,"90th_percentile":7983.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6465.21,"10th_percentile":6465.21,"90th_percentile":6465.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12477.83,"maximum":67559.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29946.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27866.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57775.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16976.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67559.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49957.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13226.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29572.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14973.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12477.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12477.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14973.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43432.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29946.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13101.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44353.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13351.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":11260.92,"10th_percentile":8053.55,"90th_percentile":12404.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19741.01,"10th_percentile":19741.01,"90th_percentile":19741.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":10562.28,"10th_percentile":489.89,"90th_percentile":12689.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23916.01,"10th_percentile":23916.01,"90th_percentile":27521.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":28028.57,"10th_percentile":24885.6,"90th_percentile":42329.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":11978.63,"10th_percentile":10044.67,"90th_percentile":12171.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":55885.42,"10th_percentile":39244.93,"90th_percentile":81042.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"13","median_amount":16976.4,"10th_percentile":14412.92,"90th_percentile":17219.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":129.13,"10th_percentile":129.13,"90th_percentile":129.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21205.0,"10th_percentile":21205.0,"90th_percentile":51470.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"64","median_amount":11056.69,"10th_percentile":5858.78,"90th_percentile":12555.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25344.78,"10th_percentile":25344.78,"90th_percentile":25344.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":12378.19,"10th_percentile":8372.87,"90th_percentile":13168.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11749.44,"10th_percentile":11749.44,"90th_percentile":11749.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13978.39,"10th_percentile":13978.39,"90th_percentile":14097.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17136.48,"10th_percentile":17136.48,"90th_percentile":17136.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":44162.82,"10th_percentile":44162.82,"90th_percentile":44162.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"62","median_amount":11858.5,"10th_percentile":8051.66,"90th_percentile":12340.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10975.28,"10th_percentile":5348.03,"90th_percentile":12378.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7044.26,"maximum":25172.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7396.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16906.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17495.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20442.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9098.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23904.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25172.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7466.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16694.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7044.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7044.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21883.99},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16906.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7396.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22348.25},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7537.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":48249.07,"10th_percentile":48249.07,"90th_percentile":48249.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4436.45,"10th_percentile":4436.45,"90th_percentile":4436.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16061.36,"10th_percentile":16061.36,"90th_percentile":16061.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16732.15,"10th_percentile":16732.15,"90th_percentile":19273.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":373.57,"10th_percentile":373.57,"90th_percentile":5729.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"17","median_amount":19252.17,"10th_percentile":10123.27,"90th_percentile":20786.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"14","median_amount":9098.8,"10th_percentile":7472.04,"90th_percentile":9342.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":20826.04,"10th_percentile":20826.04,"90th_percentile":20826.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25294.69,"10th_percentile":25294.69,"90th_percentile":25294.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12583.07,"10th_percentile":12583.07,"90th_percentile":12583.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6429.82,"10th_percentile":408.47,"90th_percentile":7552.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11863.44,"10th_percentile":11863.44,"90th_percentile":11863.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7379.65,"10th_percentile":7379.65,"90th_percentile":7379.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6623.08,"10th_percentile":6623.08,"90th_percentile":6953.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7714.37,"10th_percentile":7714.37,"90th_percentile":7714.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12682.95,"10th_percentile":12682.95,"90th_percentile":12682.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":17981.43,"10th_percentile":3924.13,"90th_percentile":22249.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2137.24,"10th_percentile":1664.51,"90th_percentile":7405.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17880.89,"10th_percentile":17880.89,"90th_percentile":17880.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6931.38,"10th_percentile":6931.38,"90th_percentile":6931.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11121.77,"maximum":46343.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21381.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11121.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39631.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14924.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46343.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43548.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11789.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26358.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13346.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11121.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11121.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13346.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37859.7},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26692.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11677.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38662.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11900.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9256.12,"10th_percentile":6714.29,"90th_percentile":11237.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":24643.03,"10th_percentile":24643.03,"90th_percentile":24643.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8714.63,"10th_percentile":8714.63,"90th_percentile":10696.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27494.57,"10th_percentile":27494.57,"90th_percentile":27494.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21288.7,"10th_percentile":16903.25,"90th_percentile":40568.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10604.17,"10th_percentile":851.84,"90th_percentile":10620.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":33258.21,"10th_percentile":27506.34,"90th_percentile":52142.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14317.67,"10th_percentile":14317.67,"90th_percentile":15167.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":78033.94,"10th_percentile":78033.94,"90th_percentile":78033.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":156.12,"10th_percentile":156.12,"90th_percentile":156.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39380.91,"10th_percentile":39380.91,"90th_percentile":42867.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":10295.49,"10th_percentile":8731.41,"90th_percentile":11810.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19930.33,"10th_percentile":19930.33,"90th_percentile":19930.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10894.93,"10th_percentile":10672.92,"90th_percentile":20101.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10803.44,"10th_percentile":10803.44,"90th_percentile":10803.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12818.54,"10th_percentile":12818.54,"90th_percentile":19596.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":32929.07,"10th_percentile":32929.07,"90th_percentile":32929.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":10873.51,"10th_percentile":10815.08,"90th_percentile":11514.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9118.8,"10th_percentile":9118.8,"90th_percentile":9118.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19240.6,"maximum":94828.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23746.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24198.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24198.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54277.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19240.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22615.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39891.81},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35943.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46647.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94828.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23972.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53599.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27138.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22615.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24198.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22615.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27138.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":82441.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54277.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23746.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84190.76},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24198.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11070.13,"maximum":41839.19,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26568.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15863.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11070.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32890.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22271.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38461.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41839.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11734.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26236.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13284.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11070.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11070.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13284.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36373.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26568.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37145.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11375.78,"10th_percentile":11375.78,"90th_percentile":11375.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":91595.98,"10th_percentile":91595.98,"90th_percentile":91595.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23991.9,"10th_percentile":23991.9,"90th_percentile":24003.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12384.42,"10th_percentile":12384.42,"90th_percentile":12384.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11952.21,"10th_percentile":11952.21,"90th_percentile":11952.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":39091.18,"10th_percentile":39091.18,"90th_percentile":39091.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14203.92,"maximum":56466.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14914.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15198.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15198.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34089.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15108.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14203.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31324.55},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24695.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36629.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56466.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15056.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33663.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17044.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14203.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15198.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14203.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17044.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49090.52},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34089.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14914.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50131.97},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15198.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13917.82,"10th_percentile":13917.82,"90th_percentile":13917.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":807.15,"10th_percentile":807.15,"90th_percentile":807.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":26321.63,"10th_percentile":26321.63,"90th_percentile":26321.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12261.43,"10th_percentile":12261.43,"90th_percentile":13969.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15718.98,"10th_percentile":15718.98,"90th_percentile":15718.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":51881.81,"10th_percentile":51881.81,"90th_percentile":51881.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13025.37,"10th_percentile":13025.37,"90th_percentile":13025.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22662.66,"maximum":119015.16,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67380.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22662.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28075.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46986.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46162.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54944.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119015.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29759.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66537.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33690.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":28075.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28075.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33690.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":103468.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67380.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":105663.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30040.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28504.79,"10th_percentile":28504.79,"90th_percentile":28504.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23146.18,"10th_percentile":23146.18,"90th_percentile":23146.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":54034.81,"10th_percentile":54034.81,"90th_percentile":129889.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26387.36,"10th_percentile":26387.36,"90th_percentile":27794.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30168.03,"10th_percentile":27614.29,"90th_percentile":49729.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26566.18,"10th_percentile":1417.38,"90th_percentile":51023.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14998.48,"maximum":57603.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15748.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35996.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36420.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14998.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48997.86},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28211.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57296.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57603.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15898.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17998.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14998.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16048.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14998.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17998.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50079.27},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35996.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15748.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51141.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16048.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15072.98,"10th_percentile":15072.98,"90th_percentile":15072.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27610.8,"10th_percentile":27610.8,"90th_percentile":27610.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":40087.63,"10th_percentile":40087.63,"90th_percentile":40087.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14048.34,"10th_percentile":14048.34,"90th_percentile":14048.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":51599.22,"10th_percentile":48243.58,"90th_percentile":57671.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":28611.29,"10th_percentile":27588.88,"90th_percentile":29884.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":59845.15,"10th_percentile":59845.15,"90th_percentile":59845.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19208.81,"10th_percentile":19208.81,"90th_percentile":19208.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13827.99,"10th_percentile":13140.78,"90th_percentile":15769.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15826.39,"10th_percentile":15826.39,"90th_percentile":15955.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12671.07,"10th_percentile":12671.07,"90th_percentile":12671.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19371.43,"maximum":77781.7,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20340.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20727.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20727.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46491.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42426.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19371.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52778.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43725.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61717.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77781.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20533.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45910.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23245.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19371.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20727.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19371.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23245.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":67621.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46491.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20340.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69055.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20727.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13974.08,"10th_percentile":13974.08,"90th_percentile":17453.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":125557.86,"10th_percentile":125557.86,"90th_percentile":125557.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18945.98,"10th_percentile":18792.64,"90th_percentile":19698.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40273.34,"10th_percentile":40273.34,"90th_percentile":42742.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":41306.42,"10th_percentile":41306.42,"90th_percentile":43361.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18704.0,"10th_percentile":17800.09,"90th_percentile":20020.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"14","median_amount":54410.29,"10th_percentile":52721.61,"90th_percentile":59111.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":44309.76,"10th_percentile":42149.19,"90th_percentile":46102.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":62039.83,"10th_percentile":62039.83,"90th_percentile":62039.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":77291.38,"10th_percentile":77291.38,"90th_percentile":81804.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17640.19,"10th_percentile":17117.93,"90th_percentile":19373.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39063.12,"10th_percentile":39063.12,"90th_percentile":39063.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12990.72,"10th_percentile":12990.72,"90th_percentile":12990.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":18977.75,"10th_percentile":18296.82,"90th_percentile":20559.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22462.89,"10th_percentile":22462.89,"90th_percentile":22462.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":65174.9,"10th_percentile":65137.86,"90th_percentile":73653.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18552.93,"10th_percentile":18552.93,"90th_percentile":19160.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19525.57,"10th_percentile":19525.57,"90th_percentile":19525.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33411.07,"maximum":148174.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35081.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35749.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35749.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80186.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":61116.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33411.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126714.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48932.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":148174.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142438.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35415.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":79184.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40093.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":33411.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35749.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33411.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40093.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":123831.93},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80186.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35081.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":126459.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35749.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18822.65,"10th_percentile":18822.65,"90th_percentile":32980.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30980.46,"10th_percentile":17944.53,"90th_percentile":32555.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":84608.83,"10th_percentile":74109.24,"90th_percentile":85211.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":60145.85,"10th_percentile":60145.85,"90th_percentile":60145.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31548.69,"10th_percentile":31548.69,"90th_percentile":32217.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"14","median_amount":124801.25,"10th_percentile":115581.19,"90th_percentile":127130.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":49176.35,"10th_percentile":46823.37,"90th_percentile":50885.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":93569.67,"10th_percentile":93569.67,"90th_percentile":93569.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":54523.34,"10th_percentile":54523.34,"90th_percentile":54523.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":291.31,"10th_percentile":291.31,"90th_percentile":291.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":30090.17,"10th_percentile":19733.21,"90th_percentile":33471.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":61016.94,"10th_percentile":61016.94,"90th_percentile":61016.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32904.28,"10th_percentile":32345.5,"90th_percentile":35222.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34256.22,"10th_percentile":34256.22,"90th_percentile":34256.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":50794.1,"10th_percentile":50794.1,"90th_percentile":50794.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":123492.18,"10th_percentile":122388.87,"90th_percentile":124542.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":32047.45,"10th_percentile":17247.14,"90th_percentile":34024.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6352.25,"maximum":26963.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11121.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23058.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7548.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26963.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20384.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6733.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15054.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6352.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7622.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17722.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15245.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18098.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6796.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10285.92,"10th_percentile":10285.92,"90th_percentile":10285.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7795.79,"maximum":31695.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18709.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13073.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27105.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10353.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31695.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29066.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8263.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18476.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9354.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7795.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7795.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9354.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25269.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18709.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8185.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25805.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8057.67,"10th_percentile":8057.67,"90th_percentile":8057.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17710.87,"10th_percentile":17710.87,"90th_percentile":17710.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":248.5,"10th_percentile":248.5,"90th_percentile":248.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":14850.2,"10th_percentile":14850.2,"90th_percentile":14850.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6514.23,"10th_percentile":6514.23,"90th_percentile":6514.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6463.66,"10th_percentile":6463.66,"90th_percentile":6463.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13935.57,"10th_percentile":13935.57,"90th_percentile":13935.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7971.68,"10th_percentile":7971.68,"90th_percentile":8565.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5746.74,"10th_percentile":5746.74,"90th_percentile":5746.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7957.81,"10th_percentile":7957.81,"90th_percentile":7957.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13582.9,"maximum":50603.85,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14262.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32598.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17992.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37304.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16792.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43622.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50603.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14397.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32191.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16299.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13582.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13582.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16299.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43993.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32598.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14262.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44926.98},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3072.2,"10th_percentile":3072.2,"90th_percentile":3072.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":17945.36,"10th_percentile":17945.36,"90th_percentile":17945.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17643.87,"10th_percentile":17643.87,"90th_percentile":17643.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10404.52,"10th_percentile":10404.52,"90th_percentile":10404.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6227.47,"maximum":27149.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14945.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11198.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23217.76},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7163.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27149.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20780.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6601.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14759.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6227.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6663.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7472.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18066.04},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14945.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6538.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18449.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6663.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":6651.6,"10th_percentile":6651.6,"90th_percentile":6651.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":22496.88,"10th_percentile":22496.88,"90th_percentile":22496.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5985.78,"10th_percentile":5985.78,"90th_percentile":5985.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8253.72,"10th_percentile":8253.72,"90th_percentile":8253.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7843.84,"maximum":31611.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8236.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18825.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13038.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7843.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27033.09},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9590.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31611.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28852.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8314.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18589.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7843.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7843.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9412.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25083.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18825.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8236.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25616.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8392.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10593.61,"10th_percentile":10593.61,"90th_percentile":10593.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5338.31,"10th_percentile":5338.31,"90th_percentile":5338.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7503.83,"10th_percentile":7503.83,"90th_percentile":7503.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6381.13,"10th_percentile":6381.13,"90th_percentile":6381.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12483.56,"maximum":50257.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13357.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13357.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29960.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17063.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35377.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22472.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41369.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50257.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29586.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14980.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12483.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13357.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12483.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14980.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43692.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29960.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44619.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13357.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21454.43,"10th_percentile":21454.43,"90th_percentile":21454.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18209.34,"10th_percentile":18209.34,"90th_percentile":18209.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12133.51,"10th_percentile":12133.51,"90th_percentile":12133.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1480.46,"10th_percentile":1480.46,"90th_percentile":1480.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5409.4,"maximum":21995.09,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6893.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15756.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6798.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6565.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14096.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5409.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16483.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21995.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6959.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15559.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6565.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6565.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19121.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15756.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6893.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19527.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6780.5,"10th_percentile":6780.5,"90th_percentile":6780.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":6721.3,"10th_percentile":6721.3,"90th_percentile":6721.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":4487.39,"10th_percentile":4487.39,"90th_percentile":4487.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1508.8,"10th_percentile":1508.8,"90th_percentile":1508.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":19076.26,"10th_percentile":19076.26,"90th_percentile":19076.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":15294.22,"10th_percentile":15294.22,"90th_percentile":15294.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7731.4,"maximum":35067.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23398.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12328.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9749.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25560.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7731.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29889.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35067.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10334.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23105.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11699.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9749.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9749.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11699.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30487.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23398.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31133.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10431.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":479.71,"10th_percentile":479.71,"90th_percentile":479.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14613.96,"10th_percentile":14613.96,"90th_percentile":14613.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8904.84,"10th_percentile":8904.84,"90th_percentile":8904.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6535.11,"maximum":23425.99,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6861.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15684.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9408.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6535.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19505.8},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7652.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22809.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23425.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15488.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6535.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6535.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7842.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20365.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15684.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6861.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20798.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6992.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5536.82,"10th_percentile":5536.82,"90th_percentile":5536.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":19850.36,"10th_percentile":19850.36,"90th_percentile":19850.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10819.86,"maximum":42713.8,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11360.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11577.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11577.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25967.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14981.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31061.42},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22637.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36321.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42713.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25643.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12983.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10819.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11577.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10819.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12983.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37134.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25967.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11360.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37922.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11577.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6661.32,"maximum":23101.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6994.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15987.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9297.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6661.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19277.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11966.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22541.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23101.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7061.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15787.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6661.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6661.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20083.83},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15987.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6994.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20509.91},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7127.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6962.86,"10th_percentile":6962.86,"90th_percentile":6962.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7191.47,"10th_percentile":7191.47,"90th_percentile":7191.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5238.15,"10th_percentile":5238.15,"90th_percentile":5935.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":18877.13,"10th_percentile":18868.23,"90th_percentile":18937.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14772.54,"10th_percentile":14772.54,"90th_percentile":14772.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1675.43,"10th_percentile":1675.43,"90th_percentile":1675.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10147.03,"10th_percentile":10147.03,"90th_percentile":10147.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":20449.18,"10th_percentile":20449.18,"90th_percentile":20449.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6963.36,"10th_percentile":6963.36,"90th_percentile":6963.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6987.61,"maximum":36886.05,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16770.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15214.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6987.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31543.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15383.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36886.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24745.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7406.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16560.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6987.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6987.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8385.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21513.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16770.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7336.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21969.61},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7476.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10389.59,"maximum":44622.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10909.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11116.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11116.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24935.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18405.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38159.57},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11707.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44622.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38467.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11012.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24623.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12467.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10389.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11116.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12467.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33442.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24935.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10909.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34152.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11116.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":504.68,"10th_percentile":504.68,"90th_percentile":504.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9613.44,"10th_percentile":9613.44,"90th_percentile":9613.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11364.01,"10th_percentile":11364.01,"90th_percentile":11364.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9395.67,"10th_percentile":9395.67,"90th_percentile":9395.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16455.65,"maximum":70892.98,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39493.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26793.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55550.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36376.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64959.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70892.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17442.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38999.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19746.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19746.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61632.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39493.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17278.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62940.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17607.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17041.07,"10th_percentile":17041.07,"90th_percentile":17041.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9893.35,"maximum":36613.15,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23744.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14742.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9893.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30566.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12184.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35743.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36613.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10486.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23447.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9893.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9893.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31830.52},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23744.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10388.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32505.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10585.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21682.84,"10th_percentile":21682.84,"90th_percentile":21682.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31504.52,"10th_percentile":31504.52,"90th_percentile":31504.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9398.6,"10th_percentile":9398.6,"90th_percentile":9398.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13698.35,"maximum":54287.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14657.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14657.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32876.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22077.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13698.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45774.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23015.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53526.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54287.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14520.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32465.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16438.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13698.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14657.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13698.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16438.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47196.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32876.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14383.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48197.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14657.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29554.9,"10th_percentile":29554.9,"90th_percentile":29554.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":888.88,"10th_percentile":888.88,"90th_percentile":888.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26146.74,"10th_percentile":26146.74,"90th_percentile":26146.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11619.49,"10th_percentile":11619.49,"90th_percentile":11619.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23671.9,"maximum":102039.04,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29545.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30108.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30108.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67533.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23671.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28138.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49079.3},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31644.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57391.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102039.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29827.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66689.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":28138.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30108.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28138.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33766.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":88710.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67533.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29545.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":90592.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30108.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22644.86,"10th_percentile":22644.86,"90th_percentile":22644.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63353.09,"10th_percentile":63353.09,"90th_percentile":63353.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12719.49,"maximum":48591.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13355.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13609.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13609.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30526.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18796.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38970.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29593.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45570.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48591.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13482.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30145.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15263.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12719.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13609.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12719.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15263.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42244.56},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30526.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13355.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43140.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13609.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19754.65,"10th_percentile":19754.65,"90th_percentile":19754.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31380.24,"10th_percentile":31380.24,"90th_percentile":31380.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24454.85,"10th_percentile":24454.85,"90th_percentile":24454.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":423.19,"10th_percentile":423.19,"90th_percentile":423.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16912.45,"maximum":66393.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17758.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18096.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18096.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40589.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26389.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16912.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54714.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37715.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63980.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66393.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17927.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40082.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20294.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16912.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18096.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16912.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20294.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57720.52},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40589.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17758.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58945.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18096.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":52606.75,"10th_percentile":52606.75,"90th_percentile":52606.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14764.47,"10th_percentile":14764.47,"90th_percentile":18582.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16710.36,"10th_percentile":16710.36,"90th_percentile":16710.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15920.16,"10th_percentile":15920.16,"90th_percentile":15920.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23644.71,"maximum":130697.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33451.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":76460.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23644.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31858.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49022.92},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68949.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57325.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":130697.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33770.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75504.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31858.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31858.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38230.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":113624.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":76460.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33451.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":116035.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34088.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19584.81,"10th_percentile":19584.81,"90th_percentile":19584.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":51971.99,"10th_percentile":51971.99,"90th_percentile":51971.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47446.46,"10th_percentile":47446.46,"90th_percentile":47446.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10132.87,"maximum":42429.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24318.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12796.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10132.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26531.89},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17415.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31025.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42429.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10740.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24014.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10132.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10132.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12159.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36887.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24318.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37669.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10842.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7626.56,"maximum":31039.96,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18303.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12802.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7626.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26544.42},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15104.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31039.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25141.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8084.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18074.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7626.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7626.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21857.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18303.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22320.81},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11979.43,"maximum":46435.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12578.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28750.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19152.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11979.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39710.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15373.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46435.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43220.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12698.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28391.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11979.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11979.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14375.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37574.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28750.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12578.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38372.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12817.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11268.55,"10th_percentile":11268.55,"90th_percentile":11268.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8552.35,"maximum":40636.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20525.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16761.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34751.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19261.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40636.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30231.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9065.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20269.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10262.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8552.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8552.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10262.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26282.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20525.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8979.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26839.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9151.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16832.85,"maximum":74508.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17674.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18011.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18011.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40398.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23143.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16832.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47982.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26755.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56109.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74508.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17842.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39893.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20199.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16832.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18011.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16832.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20199.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64776.06},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40398.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17674.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66150.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18011.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18051.88,"10th_percentile":18051.88,"90th_percentile":18051.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6777.49,"maximum":25518.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7116.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16265.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10261.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6777.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21275.63},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10186.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24878.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25518.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7184.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16062.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8132.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6777.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6777.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8132.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22184.91},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16265.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7116.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22655.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6766.78,"10th_percentile":6766.78,"90th_percentile":6766.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":172.28,"10th_percentile":172.28,"90th_percentile":172.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6951.75,"10th_percentile":6951.75,"90th_percentile":6951.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":19571.34,"10th_percentile":19571.34,"90th_percentile":21620.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8916.86,"10th_percentile":8916.86,"90th_percentile":8916.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6816.42,"10th_percentile":6816.42,"90th_percentile":6816.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5013.4,"10th_percentile":5013.4,"90th_percentile":7608.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10759.62,"maximum":40293.94,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11512.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11512.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25823.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14062.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10759.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29156.89},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11688.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34094.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40293.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25500.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10759.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11512.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10759.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12911.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35030.5},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25823.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35773.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11512.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":24030.77,"10th_percentile":24030.77,"90th_percentile":24030.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6998.37,"maximum":26461.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16796.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10914.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6998.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22628.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11287.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26461.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24822.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7418.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16586.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6998.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6998.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8398.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21580.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16796.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7348.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22038.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10599.46,"10th_percentile":10599.46,"90th_percentile":10599.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":360.97,"10th_percentile":360.97,"90th_percentile":360.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23044.95,"10th_percentile":23044.95,"90th_percentile":23044.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5997.03,"10th_percentile":5997.03,"90th_percentile":5997.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4820.6,"10th_percentile":4820.6,"90th_percentile":4820.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4850.4,"maximum":24204.87,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16575.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9983.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20699.26},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4850.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24204.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20962.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7320.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16368.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6906.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6906.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18224.56},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16575.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7251.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18611.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8218.38,"maximum":35945.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10286.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10286.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23072.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13295.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27565.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8218.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32234.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35945.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10190.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22784.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11536.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9613.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10286.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9613.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11536.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31250.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23072.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10094.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31913.14},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10286.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9051.46,"maximum":33334.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9504.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21723.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10717.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22221.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20810.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25985.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33334.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9594.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21451.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10861.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9051.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10861.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28979.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21723.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9504.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29594.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9685.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13432.91,"maximum":51564.99,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14949.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15234.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15234.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34170.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13432.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14237.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27850.66},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31446.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32567.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51564.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15091.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33743.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17085.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14237.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15234.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14237.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17085.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44829.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34170.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14949.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45780.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15234.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12278.47,"maximum":47312.46,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12892.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29468.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16898.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12278.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35036.51},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21266.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40970.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47312.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13015.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29099.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14734.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12278.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12278.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14734.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41132.22},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29468.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12892.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42004.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9289.52,"10th_percentile":9289.52,"90th_percentile":9289.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10974.04,"maximum":37699.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26337.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15549.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10974.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32239.23},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21458.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37699.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36532.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11632.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26008.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13168.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10974.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10974.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13168.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31760.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26337.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11522.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32434.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11742.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18131.55,"maximum":69740.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19038.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19400.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19400.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43515.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21364.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18131.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44296.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43177.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51797.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69740.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19219.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42971.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21757.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18131.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19400.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18131.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21757.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60630.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43515.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19038.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61916.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19400.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7268.72,"maximum":26275.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7632.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17444.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10087.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7268.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20915.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11849.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24457.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26275.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7704.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17226.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8722.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7268.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7268.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8722.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22843.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17444.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7632.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23327.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7777.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":142.04,"10th_percentile":142.04,"90th_percentile":142.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":22747.67,"10th_percentile":22747.67,"90th_percentile":22747.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":576.66,"10th_percentile":576.66,"90th_percentile":5522.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16793.67,"10th_percentile":16474.28,"90th_percentile":16924.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10310.48,"10th_percentile":10310.48,"90th_percentile":10310.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6836.93,"10th_percentile":6836.93,"90th_percentile":6836.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":21939.96,"10th_percentile":17231.62,"90th_percentile":31142.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10387.09,"10th_percentile":10049.77,"90th_percentile":10499.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":21484.76,"10th_percentile":21484.76,"90th_percentile":21484.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":129.13,"10th_percentile":129.13,"90th_percentile":129.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26218.77,"10th_percentile":26218.77,"90th_percentile":26218.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6170.28,"10th_percentile":6170.28,"90th_percentile":6170.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6924.01,"10th_percentile":6924.01,"90th_percentile":6924.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1175.18,"10th_percentile":1175.18,"90th_percentile":1175.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":19843.36,"10th_percentile":19843.36,"90th_percentile":19843.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6457.03,"10th_percentile":2257.04,"90th_percentile":7221.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9309.62,"maximum":35831.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9775.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9961.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9961.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13159.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27283.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14127.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31904.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35831.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9868.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22063.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9309.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9961.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9309.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11171.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31150.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22343.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9775.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31811.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9961.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":26165.8,"10th_percentile":26165.8,"90th_percentile":26165.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13271.28,"10th_percentile":13271.28,"90th_percentile":13271.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9581.11,"10th_percentile":9581.11,"90th_percentile":9581.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7744.16,"maximum":28482.05,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18585.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11331.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23493.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9212.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27472.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28482.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8208.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18353.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9292.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7744.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9292.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24761.55},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18585.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25286.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8286.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7241.2,"10th_percentile":7097.57,"90th_percentile":7494.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5027.84,"10th_percentile":5027.84,"90th_percentile":5027.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7668.37,"10th_percentile":7668.37,"90th_percentile":7668.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17535.37,"10th_percentile":12682.61,"90th_percentile":19416.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"13","median_amount":9638.82,"10th_percentile":5282.39,"90th_percentile":16924.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6421.23,"10th_percentile":5914.08,"90th_percentile":7955.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":22254.83,"10th_percentile":22254.83,"90th_percentile":22254.83},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"17","median_amount":21846.37,"10th_percentile":15683.85,"90th_percentile":26067.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"13","median_amount":8116.12,"10th_percentile":7702.3,"90th_percentile":9417.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":25053.51,"10th_percentile":25053.51,"90th_percentile":25053.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10334.62,"10th_percentile":10334.62,"90th_percentile":10334.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":6078.71,"10th_percentile":398.0,"90th_percentile":7577.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13829.58,"10th_percentile":13164.69,"90th_percentile":14610.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4652.69,"10th_percentile":4652.69,"90th_percentile":4652.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":7470.09,"10th_percentile":7364.07,"90th_percentile":8067.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5765.45,"10th_percentile":4930.07,"90th_percentile":8305.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":22507.58,"10th_percentile":17740.15,"90th_percentile":25129.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":6132.27,"10th_percentile":692.18,"90th_percentile":7452.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7264.73,"10th_percentile":7264.73,"90th_percentile":7264.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12842.17,"maximum":61352.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15918.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16221.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16221.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36385.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12842.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15160.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26625.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18341.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31135.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61352.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16070.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35930.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18192.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15160.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16221.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15160.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18192.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53338.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36385.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15918.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54469.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16221.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13244.9,"10th_percentile":13244.9,"90th_percentile":13244.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8597.66,"10th_percentile":8597.66,"90th_percentile":8597.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":32231.59,"10th_percentile":32231.59,"90th_percentile":32231.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13834.22,"10th_percentile":11082.39,"90th_percentile":15452.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26882.04,"10th_percentile":14979.38,"90th_percentile":32484.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13258.21,"10th_percentile":13160.16,"90th_percentile":18830.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":26003.38,"10th_percentile":21688.02,"90th_percentile":37226.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16090.95,"10th_percentile":16090.95,"90th_percentile":16090.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":129.13,"10th_percentile":129.13,"90th_percentile":129.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41271.47,"10th_percentile":41271.47,"90th_percentile":41271.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8182.93,"10th_percentile":8182.93,"90th_percentile":8182.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12878.21,"10th_percentile":7651.46,"90th_percentile":16013.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29191.58,"10th_percentile":27290.42,"90th_percentile":31123.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21030.79,"10th_percentile":21030.79,"90th_percentile":21131.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14889.4,"10th_percentile":14783.33,"90th_percentile":16318.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9989.73,"10th_percentile":9989.73,"90th_percentile":9989.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":25357.18,"10th_percentile":25357.18,"90th_percentile":43601.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14734.1,"10th_percentile":5820.46,"90th_percentile":15671.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14046.7,"10th_percentile":14046.7,"90th_percentile":15237.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11041.45,"maximum":43056.85,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11593.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11814.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11814.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26499.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27462.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20360.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12531.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23809.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43056.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11703.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26168.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11041.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11814.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11041.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13249.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37432.5},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26499.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11593.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38226.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11814.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10532.25,"10th_percentile":10532.25,"90th_percentile":10532.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20999.06,"10th_percentile":20999.06,"90th_percentile":20999.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17728.53,"maximum":67036.04,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18614.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18969.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18969.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42548.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31075.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23493.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22016.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27472.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67036.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18792.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42016.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21274.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17728.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18969.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17728.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21274.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":58279.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42548.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18614.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59515.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18969.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":30852.19,"10th_percentile":30852.19,"90th_percentile":30852.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":61007.73,"10th_percentile":61007.73,"90th_percentile":61007.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":22215.84,"10th_percentile":22215.84,"90th_percentile":22215.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7965.79,"10th_percentile":7965.79,"90th_percentile":7965.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26625.87,"maximum":110788.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28530.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29074.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29074.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65213.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40286.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27172.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26625.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45346.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31135.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110788.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28802.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64398.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32606.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27172.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29074.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27172.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32606.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":96316.41},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65213.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28530.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98359.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29074.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":27100.83,"10th_percentile":27100.83,"90th_percentile":27100.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":45260.05,"10th_percentile":45260.05,"90th_percentile":45260.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26552.85,"10th_percentile":26552.85,"90th_percentile":26552.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25638.81,"10th_percentile":25638.81,"90th_percentile":25638.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24065.82,"10th_percentile":24065.82,"90th_percentile":24065.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19767.28,"maximum":86013.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20755.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47441.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35477.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73556.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30660.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86013.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74079.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46848.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23720.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23720.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64402.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47441.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20755.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65768.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":46525.73,"10th_percentile":46525.73,"90th_percentile":46525.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":72269.44,"10th_percentile":72269.44,"90th_percentile":72269.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9013.13,"10th_percentile":9013.13,"90th_percentile":9013.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15819.28,"10th_percentile":15819.28,"90th_percentile":15819.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19767.28,"maximum":94061.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20755.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47441.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38796.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80438.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27563.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94061.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74079.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20953.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46848.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23720.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23720.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64402.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47441.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20755.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65768.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21150.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16228.69,"10th_percentile":16228.69,"90th_percentile":16228.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35215.68,"10th_percentile":35215.68,"90th_percentile":35215.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":42091.6,"10th_percentile":42091.6,"90th_percentile":42091.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":72547.36,"10th_percentile":72547.36,"90th_percentile":81076.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":26749.12,"10th_percentile":26749.12,"90th_percentile":26749.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18232.38,"10th_percentile":18232.38,"90th_percentile":18232.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6883.26,"10th_percentile":6883.26,"90th_percentile":6883.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35156.52,"10th_percentile":35156.52,"90th_percentile":35156.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26509.58,"maximum":115379.7,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27835.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28365.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28365.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63622.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47590.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26509.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98669.2},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38522.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115379.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112753.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28100.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62827.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31811.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26509.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28365.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26509.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31811.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":98025.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63622.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27835.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":100104.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28365.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64453.47,"10th_percentile":64453.47,"90th_percentile":64453.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":101788.82,"10th_percentile":101788.82,"90th_percentile":101788.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":38618.19,"10th_percentile":38618.19,"90th_percentile":38618.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":76252.08,"10th_percentile":76252.08,"90th_percentile":76252.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16093.98,"10th_percentile":16093.98,"90th_percentile":16093.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6981.87,"maximum":28241.45,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16756.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11648.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24151.23},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10787.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28241.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24393.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7400.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16547.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6981.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6981.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8378.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21206.91},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16756.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7330.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21656.81},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":30263.9,"10th_percentile":30263.9,"90th_percentile":30263.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":3251.68,"10th_percentile":3251.68,"90th_percentile":3251.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":371.31,"10th_percentile":371.31,"90th_percentile":371.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23825.46,"10th_percentile":23825.46,"90th_percentile":23825.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9017.84,"10th_percentile":9017.84,"90th_percentile":9017.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6733.65,"10th_percentile":6733.65,"90th_percentile":6733.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11309.94,"10th_percentile":11309.94,"90th_percentile":11309.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2169.93,"10th_percentile":2169.93,"90th_percentile":2169.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6505.55,"10th_percentile":6505.55,"90th_percentile":6505.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17339.23,"10th_percentile":17339.23,"90th_percentile":17339.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8607.57,"maximum":34904.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20658.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14396.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29849.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15187.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34904.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32722.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9124.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20399.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10329.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8607.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8607.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10329.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28447.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20658.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9037.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29051.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9210.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":690.35,"10th_percentile":690.35,"90th_percentile":690.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":14756.97,"10th_percentile":14756.97,"90th_percentile":14756.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":431.58,"10th_percentile":431.58,"90th_percentile":8546.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21444.85,"10th_percentile":21444.85,"90th_percentile":21444.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":14593.64,"10th_percentile":14593.64,"90th_percentile":14593.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":463.64,"10th_percentile":463.64,"90th_percentile":7131.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":26143.94,"10th_percentile":25016.7,"90th_percentile":30193.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13864.2,"10th_percentile":13864.2,"90th_percentile":15387.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6198.04,"10th_percentile":418.7,"90th_percentile":8591.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15325.48,"10th_percentile":15325.48,"90th_percentile":15325.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15134.04,"10th_percentile":15134.04,"90th_percentile":15134.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9145.78,"10th_percentile":8932.69,"90th_percentile":9184.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":335.32,"10th_percentile":335.32,"90th_percentile":335.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":3743.97,"10th_percentile":3743.97,"90th_percentile":3743.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7707.55,"10th_percentile":790.59,"90th_percentile":9458.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13865.44,"maximum":56333.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14558.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14836.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14836.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33277.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20006.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13865.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41479.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22714.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48504.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56333.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14697.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32861.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16638.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13865.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14836.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13865.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16638.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48974.99},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33277.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14558.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50013.99},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14836.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12714.49,"10th_percentile":12474.46,"90th_percentile":14821.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":23081.38,"10th_percentile":23081.38,"90th_percentile":23081.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15175.84,"10th_percentile":15175.84,"90th_percentile":15175.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13458.56,"10th_percentile":13458.56,"90th_percentile":13458.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":41896.07,"10th_percentile":41896.07,"90th_percentile":44905.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23321.69,"10th_percentile":23321.69,"90th_percentile":23321.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8201.2,"10th_percentile":8201.2,"90th_percentile":8201.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12440.62,"10th_percentile":12293.68,"90th_percentile":12659.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14254.02,"10th_percentile":14254.02,"90th_percentile":14254.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13637.57,"10th_percentile":8966.37,"90th_percentile":32665.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12528.7,"10th_percentile":12528.7,"90th_percentile":12528.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7174.78,"maximum":27124.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17219.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11187.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7174.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23195.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11448.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27124.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26491.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7605.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17004.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7174.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7174.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23031.25},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17219.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7533.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23519.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7677.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9149.7,"maximum":34721.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9607.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9790.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9790.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21959.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14321.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29692.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15112.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34721.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33133.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9698.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21684.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10979.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9149.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9790.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10979.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28805.18},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21959.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9607.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29416.28},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9790.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10965.43,"maximum":47501.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11513.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26317.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19592.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10965.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40621.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26313.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47501.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43594.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11623.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25988.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13158.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10965.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10965.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13158.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37900.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26317.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11513.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38704.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11733.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7830.93,"maximum":33827.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18794.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13952.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28928.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12868.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33827.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27320.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8300.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18559.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9397.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7830.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7830.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9397.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23751.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18794.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24255.19},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8379.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":647.53,"10th_percentile":647.53,"90th_percentile":647.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7372.43,"10th_percentile":7372.43,"90th_percentile":7372.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":18376.11,"10th_percentile":18376.11,"90th_percentile":18376.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7528.14,"10th_percentile":7528.14,"90th_percentile":7528.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8192.56,"10th_percentile":8192.56,"90th_percentile":8192.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10613.33,"maximum":45189.99,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25471.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18639.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10613.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38645.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17436.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45189.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40535.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11250.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25153.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12736.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10613.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10613.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12736.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35240.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25471.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11144.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35987.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":47894.48,"10th_percentile":47894.48,"90th_percentile":47894.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3300.85,"10th_percentile":3300.85,"90th_percentile":3300.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9945.67,"10th_percentile":9945.67,"90th_percentile":9945.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":33374.92,"10th_percentile":33374.92,"90th_percentile":33374.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17636.34,"10th_percentile":17636.34,"90th_percentile":17636.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9326.27,"10th_percentile":573.77,"90th_percentile":10395.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10622.19,"10th_percentile":10196.01,"90th_percentile":10872.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9857.47,"10th_percentile":9857.47,"90th_percentile":9857.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12662.76,"10th_percentile":12662.76,"90th_percentile":12662.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10053.99,"10th_percentile":9329.4,"90th_percentile":10213.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17563.59,"maximum":70027.64,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18441.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18793.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18793.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42152.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25602.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53082.58},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32595.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62072.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70027.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18617.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41625.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21076.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18793.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17563.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21076.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60880.2},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42152.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18441.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62171.76},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18793.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18154.67,"10th_percentile":18154.67,"90th_percentile":18154.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16496.24,"10th_percentile":16496.24,"90th_percentile":16496.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":39857.92,"10th_percentile":39857.92,"90th_percentile":39857.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16994.7,"10th_percentile":16994.7,"90th_percentile":16994.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14984.75,"10th_percentile":607.38,"90th_percentile":16931.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16585.77,"10th_percentile":16585.77,"90th_percentile":16585.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17145.93,"10th_percentile":17145.93,"90th_percentile":17145.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8125.67,"maximum":40680.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8531.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19501.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16779.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8125.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34789.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11033.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40680.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29545.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19257.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8125.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8125.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9750.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25685.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19501.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8531.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26230.73},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8694.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7471.54,"10th_percentile":7471.54,"90th_percentile":7471.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7924.94,"10th_percentile":7924.94,"90th_percentile":7924.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7647.04,"10th_percentile":7647.04,"90th_percentile":7647.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9021.78,"10th_percentile":9021.78,"90th_percentile":9021.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27102.22,"10th_percentile":27102.22,"90th_percentile":27102.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":342.72,"10th_percentile":342.72,"90th_percentile":342.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7923.1,"10th_percentile":7923.1,"90th_percentile":7923.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11280.96,"maximum":48819.98,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12070.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12070.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27074.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20136.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41749.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16274.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48819.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42967.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11957.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26735.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13537.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11280.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12070.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11280.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13537.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37354.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27074.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38147.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12070.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":757.46,"10th_percentile":757.46,"90th_percentile":9999.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10990.26,"10th_percentile":10990.26,"90th_percentile":11608.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25320.68,"10th_percentile":25320.68,"90th_percentile":25320.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10547.57,"10th_percentile":10547.57,"90th_percentile":10547.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":41200.29,"10th_percentile":36836.69,"90th_percentile":50947.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16517.85,"10th_percentile":16517.85,"90th_percentile":16517.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43826.72,"10th_percentile":43826.72,"90th_percentile":43826.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":859.03,"10th_percentile":765.33,"90th_percentile":11956.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21008.88,"10th_percentile":21008.88,"90th_percentile":21008.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10696.59,"10th_percentile":10696.59,"90th_percentile":10696.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10738.27,"10th_percentile":8880.29,"90th_percentile":11795.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":29129.61,"10th_percentile":29129.61,"90th_percentile":29129.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17661.84,"maximum":71702.69,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18898.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18898.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42388.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25267.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17661.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52387.18},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31902.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61259.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71702.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18721.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41858.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21194.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17661.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18898.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17661.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21194.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62336.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42388.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18544.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63658.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18898.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17268.87,"10th_percentile":17268.87,"90th_percentile":17268.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47037.31,"10th_percentile":47037.31,"90th_percentile":47037.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42216.8,"10th_percentile":42216.8,"90th_percentile":42216.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":82165.79,"10th_percentile":82165.79,"90th_percentile":82165.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17317.82,"10th_percentile":17317.82,"90th_percentile":17317.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17944.51,"10th_percentile":17521.9,"90th_percentile":18414.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17321.55,"10th_percentile":17321.55,"90th_percentile":17321.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17629.74,"10th_percentile":17629.74,"90th_percentile":17629.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7693.96,"maximum":27962.84,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8078.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8232.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8232.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10819.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22431.51},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10816.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26230.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27962.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18234.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7693.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8232.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9232.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24310.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18465.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8078.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24825.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8232.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7374.29,"10th_percentile":7341.97,"90th_percentile":7498.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13618.75,"maximum":61432.96,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14963.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15248.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15248.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13618.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14251.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28235.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17124.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33017.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61432.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15106.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33775.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17101.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14251.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15248.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14251.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17101.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53408.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34203.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14963.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54541.26},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15248.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14554.99,"10th_percentile":14554.99,"90th_percentile":14554.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15287.54,"10th_percentile":15287.54,"90th_percentile":15287.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14763.99,"10th_percentile":14763.99,"90th_percentile":14763.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12757.03,"maximum":36039.9,"payers_information":[{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14865.19},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30820.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12757.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36039.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20604.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17912.9},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18292.91}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13240.78,"maximum":40277.95,"payers_information":[{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16613.24},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34444.48},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13240.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40277.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30837.01},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26808.89},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27377.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":21459.84,"10th_percentile":21459.84,"90th_percentile":21459.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7946.73,"10th_percentile":7946.73,"90th_percentile":7946.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7969.84,"10th_percentile":7969.84,"90th_percentile":7969.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31952.22,"10th_percentile":31952.22,"90th_percentile":31952.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22074.94,"maximum":53519.57,"payers_information":[{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22074.94},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45768.3},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26023.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53519.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47785.31},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41543.3},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42424.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6393.33,"10th_percentile":6393.33,"90th_percentile":6393.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12274.1,"10th_percentile":12274.1,"90th_percentile":12274.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8798.06,"10th_percentile":8798.06,"90th_percentile":8798.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2096.28,"10th_percentile":2096.28,"90th_percentile":2096.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6031.83,"maximum":28336.79,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17253.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17282.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21498.04},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6031.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25138.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28336.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7620.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17038.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8626.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7189.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7189.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8626.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24635.27},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17253.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7548.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25157.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7692.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":28455.12,"10th_percentile":28455.12,"90th_percentile":28455.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5530.67,"10th_percentile":5530.67,"90th_percentile":5530.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15022.14,"maximum":56296.09,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36053.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23220.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48142.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15395.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56296.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53230.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15923.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35602.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15022.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18026.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46277.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36053.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15773.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47259.21},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16073.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14571.19,"10th_percentile":14571.19,"90th_percentile":14571.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13307.0,"10th_percentile":13307.0,"90th_percentile":13307.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1351.26,"10th_percentile":1351.26,"90th_percentile":1351.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6545.23,"10th_percentile":6545.23,"90th_percentile":6545.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8663.5,"maximum":32798.18,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20792.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13528.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8663.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28048.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11870.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32798.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32215.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9183.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20532.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8663.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8663.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28007.2},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20792.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9096.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28601.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9269.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":73203.57,"10th_percentile":73203.57,"90th_percentile":73203.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2541.49,"10th_percentile":2541.49,"90th_percentile":2541.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19330.95,"10th_percentile":16935.94,"90th_percentile":21579.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15813.53,"10th_percentile":12769.38,"90th_percentile":21918.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1583.85,"10th_percentile":1583.85,"90th_percentile":1583.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"16","median_amount":28374.91,"10th_percentile":17613.41,"90th_percentile":33660.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10713.49,"10th_percentile":9773.93,"90th_percentile":12069.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8199.35,"10th_percentile":8199.35,"90th_percentile":19749.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31231.59,"10th_percentile":31231.59,"90th_percentile":31231.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2077.03,"10th_percentile":427.59,"90th_percentile":8422.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17132.25,"10th_percentile":17132.25,"90th_percentile":17132.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6767.98,"10th_percentile":6767.98,"90th_percentile":6767.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8795.51,"10th_percentile":8795.51,"90th_percentile":8795.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8584.3,"10th_percentile":8353.47,"90th_percentile":9108.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8921.17,"10th_percentile":8921.17,"90th_percentile":10241.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":29878.61,"10th_percentile":29878.61,"90th_percentile":29878.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6559.31,"10th_percentile":719.57,"90th_percentile":9074.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":23187.89,"10th_percentile":23187.89,"90th_percentile":23187.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":357.72,"10th_percentile":357.72,"90th_percentile":357.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12776.15,"maximum":47763.68,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30662.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17702.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12776.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36702.98},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24669.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42918.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47763.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13542.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30279.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15331.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12776.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12776.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15331.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41524.49},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30662.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13414.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42405.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13670.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":229.71,"10th_percentile":229.71,"90th_percentile":229.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11901.15,"10th_percentile":11901.15,"90th_percentile":11901.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":42921.53,"10th_percentile":42921.53,"90th_percentile":42921.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":589.56,"10th_percentile":550.95,"90th_percentile":13449.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26543.5,"10th_percentile":26543.5,"90th_percentile":26543.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9366.31,"10th_percentile":9366.31,"90th_percentile":22108.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11647.29,"10th_percentile":11647.29,"90th_percentile":11647.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":990.52,"10th_percentile":990.52,"90th_percentile":990.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":379.97,"10th_percentile":379.97,"90th_percentile":379.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12041.03,"10th_percentile":11783.37,"90th_percentile":13202.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":35747.07,"10th_percentile":35747.07,"90th_percentile":35747.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6694.31,"maximum":35113.17,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16066.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14482.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30027.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12090.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35113.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23181.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15865.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6694.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6694.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20153.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16066.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7029.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20581.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":163.93,"10th_percentile":163.93,"90th_percentile":163.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11399.01,"10th_percentile":11399.01,"90th_percentile":11399.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":29118.29,"10th_percentile":29118.29,"90th_percentile":29118.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":355.97,"10th_percentile":355.97,"90th_percentile":355.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":183.91,"10th_percentile":183.91,"90th_percentile":183.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8629.08,"maximum":45867.64,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9060.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20709.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18918.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8629.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39224.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16577.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45867.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32567.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9146.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20450.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8629.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8629.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10354.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28313.5},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20709.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9060.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28914.16},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9233.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8343.51,"10th_percentile":8343.51,"90th_percentile":9005.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7891.12,"10th_percentile":6309.02,"90th_percentile":8568.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12775.46,"10th_percentile":12775.46,"90th_percentile":31964.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":14337.57,"10th_percentile":14337.57,"90th_percentile":32196.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7528.33,"10th_percentile":7290.43,"90th_percentile":8303.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36032.81,"10th_percentile":36032.81,"90th_percentile":36032.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16821.0,"10th_percentile":16821.0,"90th_percentile":16821.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1665.25,"10th_percentile":1665.25,"90th_percentile":1665.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":208.8,"10th_percentile":208.8,"90th_percentile":208.8},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":7360.14,"10th_percentile":1319.84,"90th_percentile":8883.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9683.84,"10th_percentile":8605.96,"90th_percentile":33133.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":267.0,"10th_percentile":267.0,"90th_percentile":267.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8798.06,"10th_percentile":8798.06,"90th_percentile":8798.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":26891.73,"10th_percentile":26891.73,"90th_percentile":26891.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6414.36,"10th_percentile":434.23,"90th_percentile":8402.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13210.0,"maximum":59383.97,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13870.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31704.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24493.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50783.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21434.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59383.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53734.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14002.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31307.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13210.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13210.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46715.39},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31704.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13870.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47706.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14134.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11883.72,"10th_percentile":11883.72,"90th_percentile":11883.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10948.91,"10th_percentile":7046.6,"90th_percentile":13598.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32552.9,"10th_percentile":32552.9,"90th_percentile":32552.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":41156.16,"10th_percentile":41156.16,"90th_percentile":43899.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12970.67,"10th_percentile":12676.14,"90th_percentile":13674.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":37538.32,"10th_percentile":37538.32,"90th_percentile":37538.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21618.47,"10th_percentile":21618.47,"90th_percentile":21618.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1738.74,"10th_percentile":1738.74,"90th_percentile":1738.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11390.96,"10th_percentile":10929.96,"90th_percentile":13195.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":47852.4,"10th_percentile":47852.4,"90th_percentile":47852.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13574.72,"10th_percentile":13338.89,"90th_percentile":15165.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8826.4,"10th_percentile":8826.4,"90th_percentile":8826.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":20677.56,"10th_percentile":20677.56,"90th_percentile":20677.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12260.4,"10th_percentile":8952.8,"90th_percentile":13440.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6789.49,"10th_percentile":6789.49,"90th_percentile":6789.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6999.8,"maximum":26882.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16799.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11088.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22989.09},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11537.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26882.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24730.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7419.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16589.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6999.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6999.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8399.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21499.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16799.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21955.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7489.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5936.06,"10th_percentile":1912.96,"90th_percentile":6572.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7018.17,"10th_percentile":7018.17,"90th_percentile":7018.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":29698.06,"10th_percentile":29698.06,"90th_percentile":29698.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5462.16,"10th_percentile":5185.52,"90th_percentile":13309.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11648.94,"10th_percentile":8512.01,"90th_percentile":15561.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"16","median_amount":10849.32,"10th_percentile":8589.12,"90th_percentile":11339.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6035.94,"10th_percentile":5555.94,"90th_percentile":6338.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"23","median_amount":22524.22,"10th_percentile":17603.28,"90th_percentile":23979.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"14","median_amount":11268.99,"10th_percentile":9583.25,"90th_percentile":11781.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":129.13,"10th_percentile":129.13,"90th_percentile":129.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":416.16,"10th_percentile":416.16,"90th_percentile":416.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":1776.02,"10th_percentile":379.94,"90th_percentile":5396.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11410.23,"10th_percentile":11410.23,"90th_percentile":12044.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8365.54,"10th_percentile":8365.54,"90th_percentile":8365.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6713.14,"10th_percentile":6589.53,"90th_percentile":7391.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7567.59,"10th_percentile":7567.59,"90th_percentile":7567.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2768.53,"10th_percentile":2768.53,"90th_percentile":2768.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":2065.74,"10th_percentile":501.97,"90th_percentile":6650.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":21964.22,"10th_percentile":21964.22,"90th_percentile":21964.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5975.86,"10th_percentile":5975.86,"90th_percentile":5975.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7470.23,"maximum":33446.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7843.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17928.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13795.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28602.45},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13155.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33446.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27245.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7918.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17704.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7470.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8964.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23686.83},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17928.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7843.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24189.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7993.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":488.55,"10th_percentile":488.55,"90th_percentile":488.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17107.23,"10th_percentile":17107.23,"90th_percentile":17107.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23081.73,"10th_percentile":23081.73,"90th_percentile":23081.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":397.01,"10th_percentile":397.01,"90th_percentile":507.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7721.37,"10th_percentile":7322.25,"90th_percentile":8094.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2801.93,"10th_percentile":2801.93,"90th_percentile":7241.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11803.74,"maximum":44991.5,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12393.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12630.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12630.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18423.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38197.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24350.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44666.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44991.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27974.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14164.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12630.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11803.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14164.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39114.43},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28328.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12393.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39944.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12630.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":451.25,"10th_percentile":451.25,"90th_percentile":451.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6345.08,"10th_percentile":6345.08,"90th_percentile":6345.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":272.8,"10th_percentile":272.8,"90th_percentile":272.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11118.84,"10th_percentile":11118.84,"90th_percentile":11118.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6179.42,"maximum":37739.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15566.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32273.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11396.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37739.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21271.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6550.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14645.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7415.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6179.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6179.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7415.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18493.24},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6488.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18885.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6611.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5824.91,"10th_percentile":5220.98,"90th_percentile":6209.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1847.73,"10th_percentile":1847.73,"90th_percentile":1847.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":20688.04,"10th_percentile":20688.04,"90th_percentile":29204.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6032.86,"10th_percentile":6032.86,"90th_percentile":6032.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5035.09,"10th_percentile":278.77,"90th_percentile":15261.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":8280.83,"10th_percentile":8280.83,"90th_percentile":8280.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5571.26,"10th_percentile":5571.26,"90th_percentile":5571.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":27917.45,"10th_percentile":20715.49,"90th_percentile":32689.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9463.13,"10th_percentile":9311.6,"90th_percentile":11595.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6930.91,"10th_percentile":6930.91,"90th_percentile":6930.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21567.54,"10th_percentile":21567.54,"90th_percentile":21688.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4214.64,"10th_percentile":340.79,"90th_percentile":6453.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7924.34,"10th_percentile":7924.34,"90th_percentile":7924.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5880.84,"10th_percentile":5880.84,"90th_percentile":6315.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6009.1,"10th_percentile":6009.1,"90th_percentile":6009.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7709.58,"10th_percentile":7709.58,"90th_percentile":7709.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":16367.65,"10th_percentile":16367.65,"90th_percentile":18064.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5847.81,"10th_percentile":5827.51,"90th_percentile":5877.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":15011.26,"10th_percentile":15011.26,"90th_percentile":15011.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5987.51,"10th_percentile":5987.51,"90th_percentile":5987.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8516.49,"maximum":43592.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9112.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9112.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20439.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17980.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8516.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37279.35},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14572.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43592.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31430.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9027.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20184.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10219.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8516.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9112.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8516.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10219.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27324.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20439.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27904.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9112.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8117.33,"10th_percentile":6807.45,"90th_percentile":8468.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8106.38,"10th_percentile":8106.38,"90th_percentile":10366.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":30473.15,"10th_percentile":26292.51,"90th_percentile":39356.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":8319.78,"10th_percentile":6874.85,"90th_percentile":8459.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":19560.08,"10th_percentile":14860.19,"90th_percentile":21617.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"12","median_amount":18232.43,"10th_percentile":11404.6,"90th_percentile":37988.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":7916.39,"10th_percentile":6992.16,"90th_percentile":8186.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"27","median_amount":37172.86,"10th_percentile":32107.4,"90th_percentile":45788.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"16","median_amount":13983.93,"10th_percentile":12041.22,"90th_percentile":15292.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":37992.97,"10th_percentile":37992.97,"90th_percentile":42137.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11808.23,"10th_percentile":11808.23,"90th_percentile":11808.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32116.81,"10th_percentile":32116.81,"90th_percentile":32401.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"39","median_amount":6750.13,"10th_percentile":434.97,"90th_percentile":8481.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15427.83,"10th_percentile":14546.88,"90th_percentile":16139.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12819.06,"10th_percentile":12819.06,"90th_percentile":12819.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":8402.46,"10th_percentile":8118.34,"90th_percentile":9344.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7917.94,"10th_percentile":7917.94,"90th_percentile":7930.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9312.57,"10th_percentile":9312.57,"90th_percentile":9312.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10030.9,"10th_percentile":10030.9,"90th_percentile":10030.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":467.13,"10th_percentile":467.13,"90th_percentile":467.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"34","median_amount":8110.47,"10th_percentile":6377.72,"90th_percentile":8891.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":24372.96,"10th_percentile":24372.96,"90th_percentile":24372.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8425.44,"10th_percentile":7727.25,"90th_percentile":8797.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11633.5,"maximum":61473.14,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16477.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16791.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16791.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37662.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11633.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24119.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23740.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28204.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61473.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16634.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37191.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18831.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15692.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16791.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18831.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53443.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37662.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16477.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54576.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16791.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13474.34,"10th_percentile":2978.26,"90th_percentile":15709.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":55819.46,"10th_percentile":55819.46,"90th_percentile":55819.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15334.31,"10th_percentile":14228.9,"90th_percentile":15648.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":34922.52,"10th_percentile":17026.67,"90th_percentile":38556.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":5887.69,"10th_percentile":5887.69,"90th_percentile":11790.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":14290.63,"10th_percentile":6898.86,"90th_percentile":15600.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"19","median_amount":24069.8,"10th_percentile":18963.69,"90th_percentile":37970.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23189.5,"10th_percentile":21150.76,"90th_percentile":41925.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":84278.23,"10th_percentile":84278.23,"90th_percentile":84278.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21090.23,"10th_percentile":21090.23,"90th_percentile":21090.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61787.71,"10th_percentile":61787.71,"90th_percentile":61787.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"47","median_amount":13645.41,"10th_percentile":6357.05,"90th_percentile":15310.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30789.51,"10th_percentile":29802.64,"90th_percentile":31268.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15839.18,"10th_percentile":15839.18,"90th_percentile":15839.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17093.13,"10th_percentile":17093.13,"90th_percentile":17093.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":15113.6,"10th_percentile":14591.84,"90th_percentile":16239.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16805.12,"10th_percentile":16805.12,"90th_percentile":16805.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17122.75,"10th_percentile":17122.75,"90th_percentile":17122.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13411.08,"10th_percentile":12681.76,"90th_percentile":20720.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":51291.32,"10th_percentile":49118.65,"90th_percentile":61960.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"34","median_amount":13249.09,"10th_percentile":6965.45,"90th_percentile":16214.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11338.33,"maximum":68284.97,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11905.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12132.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12132.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27211.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28165.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11338.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58395.23},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20258.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68284.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43412.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12018.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26871.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11338.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12132.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11338.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13606.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37741.48},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27211.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11905.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38542.16},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12132.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":78278.45,"10th_percentile":78278.45,"90th_percentile":78278.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10975.37,"10th_percentile":10975.37,"90th_percentile":10975.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10629.53,"10th_percentile":10629.53,"90th_percentile":10629.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13872.61,"maximum":76504.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14566.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14843.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14843.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33294.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31555.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65424.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25139.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76504.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55035.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14704.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32878.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16647.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13872.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14843.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13872.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16647.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47846.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33294.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14566.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48861.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14843.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12413.96,"10th_percentile":12413.96,"90th_percentile":12413.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12925.26,"10th_percentile":12925.26,"90th_percentile":14882.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28401.41,"10th_percentile":28401.41,"90th_percentile":28401.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":33184.48,"10th_percentile":33184.48,"90th_percentile":33184.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13165.01,"10th_percentile":13165.01,"90th_percentile":13165.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":64982.84,"10th_percentile":62740.66,"90th_percentile":66385.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23205.32,"10th_percentile":23205.32,"90th_percentile":23205.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13252.52,"10th_percentile":13017.83,"90th_percentile":13453.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9377.42,"10th_percentile":9377.42,"90th_percentile":9377.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13355.53,"10th_percentile":13355.53,"90th_percentile":13355.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":30462.94,"10th_percentile":30462.94,"90th_percentile":30462.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13408.69,"10th_percentile":12871.15,"90th_percentile":13473.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21043.03,"maximum":93555.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22095.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22516.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22516.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50503.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38588.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21043.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80006.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35359.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93555.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83542.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22305.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49871.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25251.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21043.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22516.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21043.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25251.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":72629.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50503.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22095.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74170.4},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22516.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19481.39,"10th_percentile":19481.39,"90th_percentile":19481.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":76105.37,"10th_percentile":76105.37,"90th_percentile":76105.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":122418.2,"10th_percentile":122418.2,"90th_percentile":122418.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19822.49,"10th_percentile":19822.49,"90th_percentile":19822.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45461.19,"10th_percentile":45461.19,"90th_percentile":45461.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":23784.31,"10th_percentile":23784.31,"90th_percentile":23784.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22440.05,"10th_percentile":22440.05,"90th_percentile":22440.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19708.77,"10th_percentile":19708.77,"90th_percentile":19708.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7867.51,"maximum":29889.79,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18882.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12328.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25560.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12449.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29889.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27579.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8339.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18646.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9441.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7867.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7867.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9441.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23977.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18882.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8260.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24485.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8418.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6942.78,"10th_percentile":6942.78,"90th_percentile":6942.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12041.64,"10th_percentile":12041.64,"90th_percentile":12041.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31394.2,"10th_percentile":31394.2,"90th_percentile":31394.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10170.16,"maximum":37812.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10678.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24408.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13939.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28900.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11382.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33794.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37812.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10780.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24103.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12204.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10170.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12204.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32873.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24408.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10678.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33570.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10882.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8720.78,"10th_percentile":8720.78,"90th_percentile":8720.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":29316.13,"10th_percentile":29316.13,"90th_percentile":29316.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9723.22,"10th_percentile":9723.22,"90th_percentile":9723.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":33241.03,"10th_percentile":33241.03,"90th_percentile":33241.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":28929.8,"10th_percentile":28929.8,"90th_percentile":28929.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13530.55,"maximum":57041.36,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32473.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19140.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13530.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39685.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23181.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46406.09},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57041.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14342.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32067.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16236.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13530.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13530.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16236.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49590.27},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32473.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50642.32},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14477.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":82586.1,"10th_percentile":82586.1,"90th_percentile":82586.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12069.63,"10th_percentile":12069.63,"90th_percentile":12069.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":492.49,"10th_percentile":492.49,"90th_percentile":492.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14617.13,"10th_percentile":14617.13,"90th_percentile":14617.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10562.42,"maximum":41248.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11090.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25349.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13523.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28038.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22631.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32787.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41248.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25032.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10562.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12674.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35860.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25349.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11090.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36621.5},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11301.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":465.71,"10th_percentile":465.71,"90th_percentile":465.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10560.96,"10th_percentile":10560.96,"90th_percentile":10560.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18364.81,"10th_percentile":18364.81,"90th_percentile":18364.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24757.76,"10th_percentile":24757.76,"90th_percentile":24757.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10064.61,"10th_percentile":10064.61,"90th_percentile":10064.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":38266.17,"10th_percentile":27123.76,"90th_percentile":48077.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":15087.27,"10th_percentile":15087.27,"90th_percentile":15087.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14254.42,"10th_percentile":14254.42,"90th_percentile":14254.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8350.48,"10th_percentile":8350.48,"90th_percentile":10432.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19397.81,"10th_percentile":19397.81,"90th_percentile":21523.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10506.98,"10th_percentile":10285.35,"90th_percentile":10892.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7111.63,"10th_percentile":7111.63,"90th_percentile":7111.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":35559.57,"10th_percentile":35559.57,"90th_percentile":35559.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":8360.78,"10th_percentile":504.39,"90th_percentile":10319.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":36218.01,"10th_percentile":36218.01,"90th_percentile":36218.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17930.75,"maximum":77386.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43033.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19369.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17930.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40158.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33664.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46959.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77386.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19006.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42495.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21516.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17930.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17930.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21516.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":67277.47},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43033.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18827.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":68704.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19185.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18337.49,"10th_percentile":18337.49,"90th_percentile":18337.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":53884.65,"10th_percentile":53884.65,"90th_percentile":53884.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18469.61,"10th_percentile":18469.61,"90th_percentile":18469.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":56430.2,"10th_percentile":56430.2,"90th_percentile":56430.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16978.02,"10th_percentile":16978.02,"90th_percentile":18130.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":27046.24,"10th_percentile":27046.24,"90th_percentile":27046.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":31396.13,"10th_percentile":31396.13,"90th_percentile":31396.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16686.04,"10th_percentile":6618.22,"90th_percentile":18922.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39350.98,"10th_percentile":39350.98,"90th_percentile":39350.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18886.93,"10th_percentile":18564.12,"90th_percentile":19240.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17158.04,"10th_percentile":17158.04,"90th_percentile":17158.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19518.02,"10th_percentile":19518.02,"90th_percentile":19518.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16526.04,"10th_percentile":10630.92,"90th_percentile":18354.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8493.73,"10th_percentile":8493.73,"90th_percentile":8493.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8583.19,"maximum":33714.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20599.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16941.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26829.48},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12232.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31373.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33714.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20342.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8583.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8583.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10299.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29310.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20599.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29932.11},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5791.06,"10th_percentile":5791.06,"90th_percentile":5791.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8668.56,"10th_percentile":8668.56,"90th_percentile":8668.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12221.1,"maximum":52116.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12832.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13076.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13076.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21496.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12221.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44568.57},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14520.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52116.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46329.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28964.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14665.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12221.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13076.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12221.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14665.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40277.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29330.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12832.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41132.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13076.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11395.78,"10th_percentile":11395.78,"90th_percentile":11476.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12989.0,"10th_percentile":12989.0,"90th_percentile":12989.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14678.0,"10th_percentile":14678.0,"90th_percentile":14678.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":17296.29,"10th_percentile":17296.29,"90th_percentile":21714.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11287.18,"10th_percentile":11287.18,"90th_percentile":11287.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":34744.24,"10th_percentile":34744.24,"90th_percentile":34744.24},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":29883.42,"10th_percentile":27394.26,"90th_percentile":45336.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":18732.85,"10th_percentile":18732.85,"90th_percentile":18732.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1761.13,"10th_percentile":1761.13,"90th_percentile":1761.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47019.21,"10th_percentile":47019.21,"90th_percentile":47019.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17349.49,"10th_percentile":17349.49,"90th_percentile":17349.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9309.72,"10th_percentile":9309.72,"90th_percentile":10705.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22598.61,"10th_percentile":22598.61,"90th_percentile":22598.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10784.81,"10th_percentile":10784.81,"90th_percentile":10784.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11964.61,"10th_percentile":11472.73,"90th_percentile":21631.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6034.15,"10th_percentile":6034.15,"90th_percentile":6034.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11579.04,"10th_percentile":11579.04,"90th_percentile":12659.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8497.99,"10th_percentile":8497.99,"90th_percentile":8497.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8293.47,"maximum":40922.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19904.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16879.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34995.79},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16345.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40922.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28472.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8791.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19655.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8293.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9952.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24753.49},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19904.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8708.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25278.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14260.57,"maximum":62193.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14973.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15258.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15258.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34225.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21648.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14260.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44884.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28663.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52486.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62193.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33797.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17112.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14260.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15258.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14260.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17112.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54069.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34225.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14973.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55216.23},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15258.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12994.28,"10th_percentile":12994.28,"90th_percentile":12994.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13661.06,"maximum":68534.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32786.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28267.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58608.23},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27502.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68534.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54315.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14480.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32376.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13661.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13661.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16393.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47220.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32786.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14344.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48222.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14617.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":59734.79,"10th_percentile":59734.79,"90th_percentile":59734.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14342.54,"10th_percentile":14342.54,"90th_percentile":14342.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17038.67,"maximum":86427.64,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17890.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18231.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18231.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40892.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35648.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17038.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73910.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34572.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86427.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69802.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18060.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40381.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20446.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17038.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18231.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17038.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20446.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60684.06},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40892.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17890.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61971.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18231.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18716.31,"10th_percentile":18716.31,"90th_percentile":18716.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":752.69,"10th_percentile":752.69,"90th_percentile":752.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":72217.15,"10th_percentile":72217.15,"90th_percentile":72217.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":34771.84,"10th_percentile":34771.84,"90th_percentile":34771.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16949.83,"10th_percentile":16949.83,"90th_percentile":16957.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35300.05,"10th_percentile":35300.05,"90th_percentile":35994.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16512.98,"10th_percentile":16512.98,"90th_percentile":16512.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":60673.32,"10th_percentile":60673.32,"90th_percentile":60673.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14930.36,"10th_percentile":14930.36,"90th_percentile":14930.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28960.67,"maximum":119229.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30408.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30987.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30987.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49177.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28960.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101961.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46219.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119229.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116567.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30698.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":68636.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34752.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":28960.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30987.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28960.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34752.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":101340.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69505.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30408.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":103490.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30987.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21662.47,"10th_percentile":21662.47,"90th_percentile":21662.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28166.89,"10th_percentile":28166.89,"90th_percentile":28166.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1284.0,"10th_percentile":1284.0,"90th_percentile":1284.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39571.58,"10th_percentile":39571.58,"90th_percentile":39571.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59368.86,"10th_percentile":59368.86,"90th_percentile":59368.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30066.49,"10th_percentile":30066.49,"90th_percentile":30096.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9701.16,"maximum":39959.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23282.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16481.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34171.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20713.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39959.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35176.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10283.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22991.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9701.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9701.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11641.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30581.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23282.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10186.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31229.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9526.69,"10th_percentile":9526.69,"90th_percentile":10795.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9211.25,"10th_percentile":9211.25,"90th_percentile":9211.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16480.02,"10th_percentile":14904.94,"90th_percentile":20187.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9150.37,"10th_percentile":9148.71,"90th_percentile":10171.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":35566.84,"10th_percentile":35038.33,"90th_percentile":37425.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":43011.67,"10th_percentile":43011.67,"90th_percentile":43011.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9522.16,"10th_percentile":9522.16,"90th_percentile":9573.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16491.4,"10th_percentile":16491.4,"90th_percentile":16491.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9242.34,"10th_percentile":9177.69,"90th_percentile":10295.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9299.53,"10th_percentile":9273.84,"90th_percentile":10552.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12907.38,"maximum":53794.29,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13552.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13810.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13810.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22188.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46003.23},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27898.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53794.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49791.05},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13681.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30590.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15488.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13810.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12907.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15488.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43287.03},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13552.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44205.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13810.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12696.43,"10th_percentile":12696.43,"90th_percentile":12696.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12822.4,"10th_percentile":12822.4,"90th_percentile":12822.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12399.53,"10th_percentile":12399.53,"90th_percentile":12399.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":49514.9,"10th_percentile":48963.5,"90th_percentile":49875.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13590.24,"10th_percentile":13590.24,"90th_percentile":13590.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12308.38,"10th_percentile":12308.38,"90th_percentile":12598.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25844.5,"10th_percentile":25844.5,"90th_percentile":25844.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12785.53,"10th_percentile":12785.53,"90th_percentile":12785.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7579.62,"10th_percentile":7579.62,"90th_percentile":7579.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10790.73,"10th_percentile":10790.73,"90th_percentile":12463.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24879.58,"maximum":102626.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59710.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34190.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70887.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51558.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82892.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102626.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26372.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58964.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29855.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24879.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29855.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":89220.57},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59710.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26123.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":91113.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26621.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":86032.2,"10th_percentile":86032.2,"90th_percentile":86032.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26289.11,"10th_percentile":26289.11,"90th_percentile":26289.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24789.04,"10th_percentile":24789.04,"90th_percentile":24789.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15203.57,"maximum":62186.14,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15963.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16267.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16267.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36488.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25649.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15203.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53179.69},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27112.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62186.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56648.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16115.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36032.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15203.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16267.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15203.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18244.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49249.04},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36488.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15963.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50293.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16267.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13643.8,"10th_percentile":13643.8,"90th_percentile":13643.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14675.27,"10th_percentile":14675.27,"90th_percentile":14675.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":26688.67,"10th_percentile":26688.67,"90th_percentile":26688.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13908.85,"10th_percentile":13908.85,"90th_percentile":15618.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":56549.89,"10th_percentile":56549.89,"90th_percentile":56549.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":25967.97,"10th_percentile":25967.97,"90th_percentile":25967.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59600.28,"10th_percentile":59600.28,"90th_percentile":59600.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14298.8,"10th_percentile":14298.8,"90th_percentile":16332.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13955.37,"10th_percentile":13955.37,"90th_percentile":13955.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":922.46,"10th_percentile":922.46,"90th_percentile":922.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":253.92,"10th_percentile":253.92,"90th_percentile":253.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14073.4,"10th_percentile":14073.4,"90th_percentile":15944.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15950.96,"10th_percentile":15950.96,"90th_percentile":15950.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18414.09,"maximum":70296.51,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19334.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44193.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28699.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18414.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59504.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30597.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69581.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70296.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19518.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43641.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22096.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18414.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18414.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22096.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61113.95},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44193.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19334.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62410.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19703.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":32021.49,"10th_percentile":32021.49,"90th_percentile":32021.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17387.66,"10th_percentile":16970.34,"90th_percentile":17958.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17340.1,"10th_percentile":17340.1,"90th_percentile":17340.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29028.8,"maximum":120174.09,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30480.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31060.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31060.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69669.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38432.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29028.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79683.39},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52163.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93178.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120174.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30770.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":68798.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34834.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":29028.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31060.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29028.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34834.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":104476.22},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69669.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30480.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":106692.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31060.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29155.61,"10th_percentile":29155.61,"90th_percentile":29155.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27911.35,"10th_percentile":27911.35,"90th_percentile":27911.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30076.54,"10th_percentile":30076.54,"90th_percentile":30076.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13196.37,"maximum":52310.79,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13856.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14120.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14120.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31671.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21576.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44734.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23920.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52310.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49305.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13988.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31275.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15835.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13196.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14120.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13196.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15835.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42865.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31671.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13856.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43774.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14120.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":2384.52,"10th_percentile":2384.52,"90th_percentile":2384.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23051.5,"10th_percentile":23051.5,"90th_percentile":23051.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45578.66,"10th_percentile":45578.66,"90th_percentile":45578.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51537.55,"10th_percentile":49937.2,"90th_percentile":54406.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16553.18,"maximum":70849.05,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39727.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29222.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16553.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60587.94},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26257.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70849.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65997.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17546.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39231.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19863.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16553.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16553.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19863.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57376.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39727.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17380.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58593.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17711.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":35533.67,"10th_percentile":35533.67,"90th_percentile":35533.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":62622.26,"10th_percentile":62622.26,"90th_percentile":63126.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16159.77,"10th_percentile":16159.77,"90th_percentile":16159.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33401.75,"maximum":129501.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35071.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35739.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35739.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80164.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48688.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33401.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100946.49},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35411.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118042.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129501.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35405.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":79162.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40082.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":33401.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35739.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33401.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40082.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":112584.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80164.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35071.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114973.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35739.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":154855.28,"10th_percentile":154855.28,"90th_percentile":154855.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":119741.29,"10th_percentile":119741.29,"90th_percentile":119741.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3434.33,"10th_percentile":3434.33,"90th_percentile":3434.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17013.57,"maximum":68769.81,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17864.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18204.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18204.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40832.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26616.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17013.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55184.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25372.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64530.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68769.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18034.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40322.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20416.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17013.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18204.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17013.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20416.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59786.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40832.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17864.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61055.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18204.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42095.39,"10th_percentile":42095.39,"90th_percentile":42095.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":29917.87,"10th_percentile":29917.87,"90th_percentile":29917.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12639.89,"10th_percentile":12639.89,"90th_percentile":12639.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16849.16,"10th_percentile":16849.16,"90th_percentile":16849.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25736.53,"maximum":103867.01,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27023.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":61767.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42841.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25736.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88823.89},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35118.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103867.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103732.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27280.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":60995.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30883.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":25736.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27538.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25736.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30883.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":90182.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":61767.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27023.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":92095.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27538.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26152.0,"10th_percentile":26152.0,"90th_percentile":26152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44443.97,"10th_percentile":44443.97,"90th_percentile":44443.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":108253.74,"10th_percentile":108253.74,"90th_percentile":108253.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23386.5,"10th_percentile":23386.5,"90th_percentile":23386.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":50614.25,"10th_percentile":50614.25,"90th_percentile":50614.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25710.1,"10th_percentile":25710.1,"90th_percentile":25710.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44357.81,"maximum":187874.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46575.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47462.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47462.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":106458.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63967.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44357.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":132625.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68649.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":155086.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":187874.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47019.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105128.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53229.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":44357.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47462.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44357.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53229.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":163333.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":106458.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46575.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":166798.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47462.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41473.83,"10th_percentile":41473.83,"90th_percentile":41473.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42015.06,"10th_percentile":42015.06,"90th_percentile":42015.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19363.55,"maximum":85196.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20331.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20719.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20719.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46472.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35140.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19363.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72857.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31982.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85196.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76261.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45891.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19363.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20719.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19363.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23236.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":66299.48},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46472.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20331.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67706.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20719.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":52043.07,"10th_percentile":52043.07,"90th_percentile":52043.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43547.28,"10th_percentile":43547.28,"90th_percentile":43547.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":80105.27,"10th_percentile":80105.27,"90th_percentile":80105.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":77265.64,"10th_percentile":76327.51,"90th_percentile":82185.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":31226.31,"10th_percentile":31191.73,"90th_percentile":31582.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18953.65,"10th_percentile":18953.65,"90th_percentile":18953.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18529.06,"10th_percentile":18529.06,"90th_percentile":18529.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":70666.99,"10th_percentile":70666.99,"90th_percentile":70666.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":68740.05,"10th_percentile":68740.05,"90th_percentile":68873.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18254.16,"10th_percentile":18254.16,"90th_percentile":18254.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23567.98,"maximum":115683.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24746.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56563.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47715.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23567.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98929.19},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35863.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115683.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94519.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24982.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55856.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28281.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23567.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23567.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28281.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":82173.09},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56563.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24746.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":83916.38},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25217.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":898.55,"10th_percentile":898.55,"90th_percentile":898.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":75495.88,"10th_percentile":75495.88,"90th_percentile":75495.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":729.23,"10th_percentile":729.23,"90th_percentile":729.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":104432.88,"10th_percentile":97458.25,"90th_percentile":124401.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":35683.28,"10th_percentile":35683.28,"90th_percentile":35683.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":23750.42,"10th_percentile":23750.42,"90th_percentile":23750.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":98654.59,"10th_percentile":98654.59,"90th_percentile":98707.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25179.38,"10th_percentile":25179.38,"90th_percentile":25179.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35116.16,"10th_percentile":35116.16,"90th_percentile":35116.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33876.48,"maximum":138207.16,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35570.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36247.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36247.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81303.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64002.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33876.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114406.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51994.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133782.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138207.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35909.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80287.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40651.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":33876.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36247.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33876.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40651.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":120153.7},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81303.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35570.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":122702.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36247.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30825.2,"10th_percentile":30825.2,"90th_percentile":30825.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":39211.67,"10th_percentile":39211.67,"90th_percentile":39211.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33018.28,"10th_percentile":31129.11,"90th_percentile":33342.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":76600.68,"10th_percentile":76600.68,"90th_percentile":76600.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":64358.46,"10th_percentile":61169.87,"90th_percentile":64818.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":116460.88,"10th_percentile":75549.08,"90th_percentile":118803.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":53248.32,"10th_percentile":52582.58,"90th_percentile":53831.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":167433.85,"10th_percentile":167433.85,"90th_percentile":167433.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":140596.93,"10th_percentile":140596.93,"90th_percentile":145325.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30916.14,"10th_percentile":30437.08,"90th_percentile":34106.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":32804.39,"10th_percentile":32211.39,"90th_percentile":35605.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":37741.37,"10th_percentile":37741.37,"90th_percentile":37741.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":117219.9,"10th_percentile":83582.99,"90th_percentile":122362.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":32489.73,"10th_percentile":20221.44,"90th_percentile":33799.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33503.42,"10th_percentile":33503.42,"90th_percentile":33503.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29324.25,"maximum":142775.01,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30790.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31376.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31376.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":70378.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58889.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29324.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":122096.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66126.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142775.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117482.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31083.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69498.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35189.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":29324.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31376.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29324.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35189.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":102136.02},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":70378.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30790.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":104302.81},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31376.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":34910.89,"10th_percentile":34910.89,"90th_percentile":34910.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":121742.83,"10th_percentile":121742.83,"90th_percentile":121742.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":113911.19,"10th_percentile":113911.19,"90th_percentile":113911.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42364.23,"maximum":176303.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44482.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45329.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45329.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101674.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":71064.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42364.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147338.15},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77386.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172291.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":176303.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44906.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":100403.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50837.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":42364.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45329.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42364.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50837.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":153273.88},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101674.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44482.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":156525.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45329.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":551.92,"10th_percentile":551.92,"90th_percentile":551.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42073.43,"10th_percentile":41499.17,"90th_percentile":61703.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99192.22,"10th_percentile":99192.22,"90th_percentile":102813.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":70940.99,"10th_percentile":70940.99,"90th_percentile":152612.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39109.57,"10th_percentile":39109.57,"90th_percentile":41547.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":140474.93,"10th_percentile":140474.93,"90th_percentile":141940.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":81312.0,"10th_percentile":81312.0,"90th_percentile":81312.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3563.05,"10th_percentile":3563.05,"90th_percentile":3563.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40090.05,"10th_percentile":40090.05,"90th_percentile":40090.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":53794.13,"10th_percentile":53794.13,"90th_percentile":53794.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41293.7,"10th_percentile":41293.7,"90th_percentile":41293.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":46179.6,"10th_percentile":46179.6,"90th_percentile":46179.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":229313.76,"10th_percentile":229313.76,"90th_percentile":229313.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40737.11,"10th_percentile":39107.91,"90th_percentile":41254.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24057.05,"maximum":205437.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25259.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96867.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25741.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39234.03,"maximum":245495.51,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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Plans","methodology":"fee schedule","standard_charge_dollar":209940.27},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87244.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":245495.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170821.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41588.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":92984.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47080.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va 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schedule","standard_charge_dollar":94161.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41195.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":151658.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41980.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57699.7,"maximum":282315.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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Plans","methodology":"fee schedule","standard_charge_dollar":241427.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":111339.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":282315.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":249109.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61161.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":136748.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69239.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va 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Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52434.65,"maximum":244974.66,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55056.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56105.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56105.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":125843.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":78149.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52434.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":162029.37},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189470.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":244974.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55580.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":124270.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62921.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":52434.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56105.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52434.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62921.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":212974.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":125843.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55056.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":217492.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56105.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40227.23,"maximum":237513.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42238.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43043.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43043.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":96545.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97966.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40227.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203114.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237513.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186527.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42640.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":95338.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48272.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":40227.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43043.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40227.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48272.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":162161.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":96545.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42238.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":165602.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43043.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43794.16,"maximum":237513.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45983.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46859.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46859.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105105.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97966.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43794.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203114.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237513.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186527.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46421.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":103792.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52552.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":43794.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46859.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43794.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52552.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":162161.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105105.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45983.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":165602.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46859.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":87453.43,"maximum":404883.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91826.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93575.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93575.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":209888.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97966.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87453.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":203114.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":237513.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":404883.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":92700.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":207264.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104944.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":87453.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93575.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87453.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":104944.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":351994.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":209888.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":91826.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":359462.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":93575.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21937.27,"maximum":98020.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":83824.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46005.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98020.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81892.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23253.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51991.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26324.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other 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state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31504.99,"maximum":126815.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":101717.08},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63796.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118943.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126815.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33395.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74666.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37805.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33080.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":112589.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33710.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40383.57,"maximum":166751.02,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":129940.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85119.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":151947.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166751.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42806.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":95709.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48460.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":40383.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43210.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40383.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48460.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":144968.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":96920.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42402.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":148044.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43210.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41293.67,"10th_percentile":41293.67,"90th_percentile":41293.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":133239.38,"10th_percentile":133239.38,"90th_percentile":133239.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":81608.92,"10th_percentile":81608.92,"90th_percentile":81608.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38708.46,"10th_percentile":38708.46,"90th_percentile":38708.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52729.38,"maximum":246393.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55365.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56420.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56420.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":126550.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58774.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121858.76},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142496.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":246393.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55893.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":124968.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63275.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":52729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56420.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63275.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":214207.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":126550.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55365.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":218752.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56420.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41462.82,"maximum":189470.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43535.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44365.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44365.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":99510.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":78149.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41462.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":162029.37},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189470.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":168147.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43950.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":98266.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49755.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":41462.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44365.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41462.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49755.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":146183.41},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":99510.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43535.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":149284.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44365.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":94139.08,"maximum":403863.45,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98846.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100728.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100728.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":225933.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":126913.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94139.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":263132.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":307696.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":403863.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99787.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":223109.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112966.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":94139.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100728.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94139.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":112966.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":351108.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":225933.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98846.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":358557.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100728.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34524.03,"maximum":265791.99,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36250.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36940.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36940.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82857.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":109629.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34524.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":227297.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":265791.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149855.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36595.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81821.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41428.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":34524.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36940.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34524.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41428.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":130280.25},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82857.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36250.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":133044.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36940.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75209.45,"maximum":388713.74,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78969.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80474.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80474.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":180502.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":160330.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":332416.12},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":388713.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":329094.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79722.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":178246.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90251.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":75209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80474.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":90251.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":286106.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":180502.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78969.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":292176.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":80474.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":100601.7,"maximum":436659.84,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105631.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107643.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107643.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":241444.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":138030.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100601.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":286181.09},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":334648.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":436659.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":106637.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":238426.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120722.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":100601.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107643.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":100601.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":120722.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":379620.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":241444.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":105631.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":387674.25},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":107643.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":232770.45,"10th_percentile":232770.45,"90th_percentile":232770.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":177560.36,"10th_percentile":177560.36,"90th_percentile":177560.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96752.98,"10th_percentile":96752.98,"90th_percentile":96752.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":87041.53,"10th_percentile":87041.53,"90th_percentile":87041.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":118902.35,"10th_percentile":98552.74,"90th_percentile":155082.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":168.61,"10th_percentile":168.61,"90th_percentile":168.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85125.2,"10th_percentile":85125.2,"90th_percentile":85125.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":101167.33,"10th_percentile":101167.33,"90th_percentile":101167.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":94733.82,"10th_percentile":94733.82,"90th_percentile":94733.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":99737.8,"10th_percentile":99737.8,"90th_percentile":99737.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":153480.19,"maximum":662300.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161154.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164223.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164223.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":368352.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":198509.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":411573.26},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":481276.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":662300.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162689.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":363748.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184176.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":153480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164223.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153480.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":184176.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":575786.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":368352.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":161154.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":588001.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":164223.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":148684.38,"10th_percentile":148684.38,"90th_percentile":148684.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":368780.73,"10th_percentile":368780.73,"90th_percentile":368780.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":211891.42,"10th_percentile":211891.42,"90th_percentile":211891.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":120951.86,"10th_percentile":120951.86,"90th_percentile":120951.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":1096.1,"10th_percentile":1096.1,"90th_percentile":1096.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":494525.2,"10th_percentile":494525.2,"90th_percentile":494525.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":580383.31,"10th_percentile":580383.31,"90th_percentile":580383.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":149871.77,"10th_percentile":149871.77,"90th_percentile":149871.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":148342.04,"10th_percentile":148342.04,"90th_percentile":148342.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":139967.69,"10th_percentile":139967.69,"90th_percentile":139967.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":158574.74,"10th_percentile":158574.74,"90th_percentile":158574.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":82533.32,"maximum":596092.45,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86659.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88310.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88310.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":198079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":245867.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82533.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":509760.06},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":596092.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":340563.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87485.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":195603.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99039.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":82533.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88310.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82533.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":99039.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":296077.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":198079.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86659.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":302358.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88310.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":202234.56,"maximum":870482.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212346.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216390.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216390.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":485362.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":349181.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202234.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":723963.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":846573.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":870482.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":214368.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":479295.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242681.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":202234.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216390.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":202234.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":242681.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":756774.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":485362.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":212346.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":772829.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":216390.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":130097.54,"10th_percentile":130097.54,"90th_percentile":130097.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12761.8,"maximum":49244.03,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13399.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30628.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27220.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12761.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39265.32},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23800.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45915.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49244.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13527.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30245.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15314.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12761.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12761.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15314.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42811.47},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30628.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13399.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43719.71},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13655.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":34318.6,"10th_percentile":34318.6,"90th_percentile":34318.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29978.08,"10th_percentile":29978.08,"90th_percentile":29978.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":42105.4,"10th_percentile":39798.61,"90th_percentile":49333.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":25637.2,"10th_percentile":25637.2,"90th_percentile":25637.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":47109.08,"10th_percentile":47109.08,"90th_percentile":47109.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51205.65,"10th_percentile":51205.65,"90th_percentile":51205.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11354.35,"10th_percentile":10171.67,"90th_percentile":13397.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":24782.3,"10th_percentile":24782.3,"90th_percentile":24782.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12557.5,"10th_percentile":12557.5,"90th_percentile":12557.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5739.79,"10th_percentile":5739.79,"90th_percentile":5739.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10723.75,"10th_percentile":10723.75,"90th_percentile":10723.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18799.18,"maximum":75040.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19739.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20115.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20115.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45118.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49768.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61912.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35204.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72398.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75040.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19927.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44554.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22559.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18799.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20115.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18799.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22559.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":65238.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45118.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19739.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":66622.21},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20115.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17258.67,"10th_percentile":17258.67,"90th_percentile":17258.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":886.47,"10th_percentile":886.47,"90th_percentile":886.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":47810.63,"10th_percentile":47810.63,"90th_percentile":47810.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":63998.66,"10th_percentile":63998.66,"90th_percentile":63998.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":2111.93,"10th_percentile":2111.93,"90th_percentile":52161.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16491.37,"10th_percentile":16491.37,"90th_percentile":16491.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19147.08,"10th_percentile":19147.08,"90th_percentile":19147.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18428.25,"10th_percentile":18284.53,"90th_percentile":18755.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37036.8,"maximum":156957.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38888.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":88888.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":78050.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37036.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81919.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59632.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95793.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":156957.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39259.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":87777.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44444.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":37036.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37036.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44444.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":136454.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":88888.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38888.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":139349.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39629.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38495.61,"10th_percentile":38495.61,"90th_percentile":38495.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":85693.86,"10th_percentile":85693.86,"90th_percentile":85693.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30999.36,"10th_percentile":30999.36,"90th_percentile":30999.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":96188.6,"10th_percentile":85402.65,"90th_percentile":117432.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":61122.24,"10th_percentile":61122.24,"90th_percentile":61122.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":84965.15,"10th_percentile":84965.15,"90th_percentile":84965.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29264.21,"10th_percentile":29264.21,"90th_percentile":29264.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35296.98,"10th_percentile":35296.98,"90th_percentile":35296.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":45594.98,"10th_percentile":45594.98,"90th_percentile":45594.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35563.73,"10th_percentile":35563.73,"90th_percentile":35563.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":68022.74,"10th_percentile":68022.74,"90th_percentile":68022.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36840.47,"10th_percentile":36840.47,"90th_percentile":36840.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38020.49,"10th_percentile":38020.49,"90th_percentile":38020.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24293.7,"maximum":91097.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25508.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25994.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25994.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58304.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37574.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24293.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77904.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46229.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91097.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88450.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25751.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57576.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29152.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24293.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25994.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24293.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29152.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":76896.22},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58304.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25508.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78527.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25994.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19289.47,"10th_percentile":19289.47,"90th_percentile":19289.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23867.73,"maximum":98741.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25061.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25538.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25538.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57282.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35643.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23867.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73900.88},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60549.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86416.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98741.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25299.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56566.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28641.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23867.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25538.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23867.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28641.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85843.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57282.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25061.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87664.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25538.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23115.04,"10th_percentile":23115.04,"90th_percentile":23115.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21748.83,"10th_percentile":21748.83,"90th_percentile":21748.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":98744.57,"10th_percentile":98744.57,"90th_percentile":98744.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24380.37,"10th_percentile":24380.37,"90th_percentile":24380.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22939.36,"10th_percentile":22939.36,"90th_percentile":22939.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28403.69,"10th_percentile":28403.69,"90th_percentile":28403.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22833.65,"10th_percentile":22833.65,"90th_percentile":22833.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23261.31,"10th_percentile":23261.31,"90th_percentile":23261.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32303.85,"maximum":131630.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33919.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34565.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34565.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":77529.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43883.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32303.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90985.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71690.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106394.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131630.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34242.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":76560.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38764.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":32303.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34565.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32303.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38764.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":114436.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":77529.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33919.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":116863.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34565.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29135.92,"10th_percentile":29135.92,"90th_percentile":29135.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29882.1,"10th_percentile":29882.1,"90th_percentile":29882.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29796.44,"10th_percentile":29409.22,"90th_percentile":33745.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30374.03,"10th_percentile":30374.03,"90th_percentile":30374.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30623.36,"10th_percentile":30623.36,"90th_percentile":30623.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13914.2,"maximum":77742.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33394.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32066.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66483.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34362.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77742.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55910.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14749.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32976.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13914.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13914.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16697.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48606.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33394.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49638.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14888.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13591.02,"10th_percentile":12918.82,"90th_percentile":14412.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21697.81,"10th_percentile":21697.81,"90th_percentile":21697.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":73207.15,"10th_percentile":73207.15,"90th_percentile":95725.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14053.38,"10th_percentile":12012.21,"90th_percentile":14834.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28704.6,"10th_percentile":24356.46,"90th_percentile":31600.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"16","median_amount":31067.69,"10th_percentile":25938.03,"90th_percentile":33019.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13320.52,"10th_percentile":13320.52,"90th_percentile":13397.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"39","median_amount":64946.83,"10th_percentile":62421.43,"90th_percentile":66899.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"19","median_amount":32735.23,"10th_percentile":31062.66,"90th_percentile":34605.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":78065.3,"10th_percentile":78065.3,"90th_percentile":78065.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8863.36,"10th_percentile":8863.36,"90th_percentile":8863.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54557.76,"10th_percentile":53250.22,"90th_percentile":55711.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":13242.87,"10th_percentile":12831.85,"90th_percentile":13899.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28464.69,"10th_percentile":26628.23,"90th_percentile":28931.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29194.07,"10th_percentile":29194.07,"90th_percentile":29194.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"32","median_amount":13576.05,"10th_percentile":13411.77,"90th_percentile":14324.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15582.57,"10th_percentile":15582.57,"90th_percentile":15582.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":46431.9,"10th_percentile":28088.35,"90th_percentile":49311.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32620.07,"10th_percentile":32620.07,"90th_percentile":32620.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":13589.4,"10th_percentile":11884.33,"90th_percentile":14363.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":46104.47,"10th_percentile":22402.78,"90th_percentile":49076.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13959.62,"10th_percentile":13959.62,"90th_percentile":13959.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20782.71,"maximum":105965.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21821.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22237.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22237.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49878.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43707.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20782.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90618.79},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50119.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105965.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87977.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22029.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49255.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20782.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22237.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20782.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":76485.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49878.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21821.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78107.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22237.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20836.46,"10th_percentile":20836.46,"90th_percentile":20953.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":169127.66,"10th_percentile":169127.66,"90th_percentile":169127.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21298.12,"10th_percentile":19997.15,"90th_percentile":21450.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47862.78,"10th_percentile":41730.93,"90th_percentile":49443.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":43959.09,"10th_percentile":43959.09,"90th_percentile":43959.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20082.84,"10th_percentile":19920.05,"90th_percentile":20436.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":85046.9,"10th_percentile":85046.9,"90th_percentile":85046.9},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"16","median_amount":88530.45,"10th_percentile":84651.63,"90th_percentile":91034.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":48799.18,"10th_percentile":48460.09,"90th_percentile":54275.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":106288.44,"10th_percentile":106288.44,"90th_percentile":106288.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88396.51,"10th_percentile":88396.51,"90th_percentile":88396.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":20709.93,"10th_percentile":18879.59,"90th_percentile":21265.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":42840.19,"10th_percentile":42840.19,"90th_percentile":42840.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":20649.38,"10th_percentile":20561.45,"90th_percentile":21245.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23135.72,"10th_percentile":23135.72,"90th_percentile":23135.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":20833.95,"10th_percentile":19638.93,"90th_percentile":21427.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":76853.17,"10th_percentile":76853.17,"90th_percentile":76853.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21497.35,"10th_percentile":21497.35,"90th_percentile":21497.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18520.22,"maximum":167811.37,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19446.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19816.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19816.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44448.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":114541.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143507.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38435.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167811.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71532.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43892.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22224.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19816.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18520.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22224.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62188.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44448.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19446.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63507.99},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19816.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33275.54,"maximum":230821.68,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35604.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35604.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":79861.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":140568.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33275.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":197391.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75193.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230821.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135750.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35272.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":78863.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39930.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":33275.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35604.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33275.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39930.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":118017.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":79861.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34939.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":120521.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35604.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29615.08,"10th_percentile":29615.08,"90th_percentile":29615.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49221.27,"maximum":191178.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52666.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52666.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":118131.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55318.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49221.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114691.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54318.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":134115.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":191178.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":116654.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59065.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":49221.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52666.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49221.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59065.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":166205.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":118131.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51682.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":169731.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52666.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48914.25,"10th_percentile":48914.25,"90th_percentile":51657.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50205.92,"10th_percentile":44788.1,"90th_percentile":52334.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":664.6,"10th_percentile":664.6,"90th_percentile":664.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":55109.11,"10th_percentile":55109.11,"90th_percentile":55109.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49223.8,"10th_percentile":43620.1,"90th_percentile":50219.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":116481.17,"10th_percentile":111941.36,"90th_percentile":117063.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":55746.47,"10th_percentile":54748.32,"90th_percentile":56922.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":44978.79,"10th_percentile":43143.42,"90th_percentile":51586.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95964.43,"10th_percentile":95964.43,"90th_percentile":95964.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6957.71,"10th_percentile":6957.71,"90th_percentile":6957.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49591.92,"10th_percentile":43514.21,"90th_percentile":96815.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50324.16,"10th_percentile":50324.16,"90th_percentile":50324.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":192425.54,"10th_percentile":192425.54,"90th_percentile":192425.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":48826.73,"10th_percentile":43901.09,"90th_percentile":50710.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52016.62,"10th_percentile":52016.62,"90th_percentile":52016.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6162.93,"maximum":33241.4,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6471.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14791.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13710.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6162.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28427.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10015.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33241.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21095.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6532.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14606.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6162.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6162.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7395.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18340.1},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14791.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6471.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18729.18},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5120.85,"10th_percentile":5120.85,"90th_percentile":5120.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":480.58,"10th_percentile":480.58,"90th_percentile":480.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":741.34,"10th_percentile":741.34,"90th_percentile":741.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8179.45,"maximum":42929.94,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19630.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17707.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36712.37},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10727.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42929.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29739.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8670.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19385.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9815.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8179.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8179.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9815.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25855.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19630.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8588.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26403.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8752.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7314.78,"10th_percentile":7314.78,"90th_percentile":8457.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":42712.9,"10th_percentile":42712.9,"90th_percentile":42712.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7640.99,"10th_percentile":7640.99,"90th_percentile":7640.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":17363.68,"10th_percentile":17187.81,"90th_percentile":17717.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8356.28,"10th_percentile":8356.28,"90th_percentile":8356.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20553.4,"10th_percentile":19483.72,"90th_percentile":37128.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11398.12,"10th_percentile":11398.12,"90th_percentile":11398.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":939.08,"10th_percentile":235.9,"90th_percentile":7210.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14443.75,"10th_percentile":14443.75,"90th_percentile":14443.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11909.32,"10th_percentile":11909.32,"90th_percentile":11909.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7825.22,"10th_percentile":7682.14,"90th_percentile":14319.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":412.37,"10th_percentile":412.37,"90th_percentile":412.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8830.49,"10th_percentile":8830.49,"90th_percentile":8830.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6492.33,"10th_percentile":6492.33,"90th_percentile":6492.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7770.21,"10th_percentile":7770.21,"90th_percentile":8325.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16224.74,"maximum":66550.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17035.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17360.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17360.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38939.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23578.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48885.09},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19799.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57164.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66550.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17198.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38452.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19469.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16224.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17360.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16224.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19469.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57857.55},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38939.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17035.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59084.99},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17360.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16166.9,"10th_percentile":16031.87,"90th_percentile":16721.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18164.96,"10th_percentile":18164.96,"90th_percentile":18164.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":109520.84,"10th_percentile":109520.84,"90th_percentile":109520.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15206.55,"10th_percentile":15013.49,"90th_percentile":16382.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":322.56,"10th_percentile":322.56,"90th_percentile":37998.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23510.32,"10th_percentile":23510.32,"90th_percentile":23510.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12934.2,"10th_percentile":12934.2,"90th_percentile":14610.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":47337.43,"10th_percentile":32921.77,"90th_percentile":117909.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":19999.19,"10th_percentile":19143.57,"90th_percentile":20476.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":67970.76,"10th_percentile":67970.76,"90th_percentile":67970.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":14153.94,"10th_percentile":751.45,"90th_percentile":16522.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33832.62,"10th_percentile":33832.62,"90th_percentile":33832.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12042.11,"10th_percentile":12042.11,"90th_percentile":12042.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12183.83,"10th_percentile":12183.83,"90th_percentile":12183.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16492.94,"10th_percentile":16055.01,"90th_percentile":16700.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13957.67,"10th_percentile":11726.63,"90th_percentile":20181.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":42860.43,"10th_percentile":42860.43,"90th_percentile":58225.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":15339.45,"10th_percentile":1645.06,"90th_percentile":16721.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":29661.09,"10th_percentile":29661.09,"90th_percentile":29661.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16469.34,"10th_percentile":14811.99,"90th_percentile":17392.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6434.71,"maximum":22044.54,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6756.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6885.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6885.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15443.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8293.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6434.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17194.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8725.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20106.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22044.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6820.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15250.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7721.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6434.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6885.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6434.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7721.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19164.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15443.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6756.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19571.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6885.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5283.65,"10th_percentile":5283.65,"90th_percentile":5283.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1705.71,"10th_percentile":1705.71,"90th_percentile":1705.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8925.62,"10th_percentile":8925.62,"90th_percentile":8925.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":359.43,"10th_percentile":359.43,"90th_percentile":359.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6731.63,"10th_percentile":6731.63,"90th_percentile":6731.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7521.86,"maximum":26927.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18052.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10873.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7521.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22544.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10074.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26362.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26927.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7973.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17826.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7521.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7521.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9026.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23410.09},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18052.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7897.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23906.73},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8048.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5474.78,"10th_percentile":5474.78,"90th_percentile":5474.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5977.73,"10th_percentile":1691.93,"90th_percentile":7116.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9866.05,"10th_percentile":9866.05,"90th_percentile":9866.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11125.42,"10th_percentile":11025.35,"90th_percentile":13506.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6250.67,"10th_percentile":6190.51,"90th_percentile":8570.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":22960.38,"10th_percentile":20130.32,"90th_percentile":26230.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10274.74,"10th_percentile":8492.66,"90th_percentile":12562.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":41184.21,"10th_percentile":41184.21,"90th_percentile":41184.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27807.05,"10th_percentile":27807.05,"90th_percentile":28334.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":398.88,"10th_percentile":385.65,"90th_percentile":7352.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7908.26,"10th_percentile":7340.02,"90th_percentile":8973.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6833.18,"10th_percentile":6833.18,"90th_percentile":6833.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":2137.94,"10th_percentile":583.94,"90th_percentile":7870.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":23775.44,"10th_percentile":23775.44,"90th_percentile":23775.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6744.35,"10th_percentile":6744.35,"90th_percentile":6744.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6304.92,"maximum":21587.14,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6620.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6746.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6746.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15131.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":7732.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6304.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16031.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6624.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18747.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21587.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6683.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14942.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6304.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6746.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6304.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7565.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18767.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15131.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6620.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19165.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6746.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6491.23,"10th_percentile":6491.23,"90th_percentile":6491.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5331.08,"maximum":17291.35,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5597.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5704.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5704.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12794.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6647.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5331.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13782.8},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6628.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16117.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17291.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5650.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12634.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5331.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5704.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5331.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6397.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15032.65},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12794.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5597.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15351.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5704.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5647.69,"10th_percentile":5647.69,"90th_percentile":5647.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5054.12,"10th_percentile":1383.07,"90th_percentile":5806.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11288.71,"10th_percentile":11288.71,"90th_percentile":11288.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":6844.52,"10th_percentile":1873.3,"90th_percentile":7133.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3958.97,"10th_percentile":3958.97,"90th_percentile":3958.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"17","median_amount":13925.22,"10th_percentile":10927.34,"90th_percentile":15336.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"11","median_amount":6310.5,"10th_percentile":5433.19,"90th_percentile":7491.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":19076.3,"10th_percentile":19076.3,"90th_percentile":19076.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12300.1,"10th_percentile":12300.1,"90th_percentile":12300.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":4379.8,"10th_percentile":873.0,"90th_percentile":5357.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4981.81,"10th_percentile":4981.81,"90th_percentile":5533.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":15399.24,"10th_percentile":15259.48,"90th_percentile":16787.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":4994.77,"10th_percentile":3356.21,"90th_percentile":5348.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":11241.58,"10th_percentile":11241.58,"90th_percentile":11241.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5101.45,"10th_percentile":5101.45,"90th_percentile":5152.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6547.3,"maximum":22848.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15713.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":7554.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6547.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15662.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8296.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18314.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22848.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6940.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15517.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7856.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6547.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7005.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6547.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7856.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19863.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15713.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6874.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20284.91},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7005.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6361.77,"10th_percentile":5606.7,"90th_percentile":6882.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2372.27,"10th_percentile":2372.27,"90th_percentile":2372.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6577.96,"10th_percentile":6577.96,"90th_percentile":6577.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14552.65,"10th_percentile":2478.67,"90th_percentile":14883.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":4827.81,"10th_percentile":4827.81,"90th_percentile":7705.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":423.1,"10th_percentile":390.57,"90th_percentile":6319.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"13","median_amount":15115.44,"10th_percentile":13384.71,"90th_percentile":16184.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":7862.74,"10th_percentile":7285.12,"90th_percentile":8496.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":21363.14,"10th_percentile":21363.14,"90th_percentile":21363.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18722.22,"10th_percentile":18722.22,"90th_percentile":18722.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":1262.71,"10th_percentile":390.03,"90th_percentile":6976.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5866.13,"10th_percentile":5866.13,"90th_percentile":5866.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6462.88,"10th_percentile":6157.09,"90th_percentile":7230.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":4450.0,"10th_percentile":4450.0,"90th_percentile":4450.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5893.62,"10th_percentile":5893.62,"90th_percentile":8722.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":5447.91,"10th_percentile":3518.62,"90th_percentile":8115.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":5536.46,"10th_percentile":547.69,"90th_percentile":6495.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":19602.11,"10th_percentile":19602.11,"90th_percentile":19602.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9905.54,"maximum":37271.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10400.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23773.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21927.19},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13765.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25640.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37271.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10499.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23476.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32402.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23773.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10400.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33090.23},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8803.52,"10th_percentile":7793.93,"90th_percentile":10531.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18330.73,"10th_percentile":18330.73,"90th_percentile":18330.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9085.59,"10th_percentile":5025.46,"90th_percentile":9989.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21425.11,"10th_percentile":16129.24,"90th_percentile":24909.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10244.09,"10th_percentile":9517.11,"90th_percentile":10593.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9257.15,"10th_percentile":8408.29,"90th_percentile":10209.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":22271.75,"10th_percentile":20231.71,"90th_percentile":22686.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12301.74,"10th_percentile":12271.53,"90th_percentile":14099.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":24244.19,"10th_percentile":24244.19,"90th_percentile":24244.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":7388.85,"10th_percentile":704.68,"90th_percentile":9792.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9582.34,"10th_percentile":9476.27,"90th_percentile":9855.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":2800.0,"10th_percentile":2800.0,"90th_percentile":2800.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9300.05,"10th_percentile":9300.05,"90th_percentile":9300.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8669.93,"10th_percentile":8669.93,"90th_percentile":8669.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":33732.03,"10th_percentile":33732.03,"90th_percentile":33732.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"28","median_amount":8480.53,"10th_percentile":1114.11,"90th_percentile":10308.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":34003.83,"10th_percentile":34003.83,"90th_percentile":34003.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10715.76,"10th_percentile":10715.76,"90th_percentile":10715.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7820.18,"maximum":30124.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8367.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8367.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18768.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12425.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25761.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9110.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30124.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28627.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8289.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18533.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9384.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7820.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8367.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7820.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9384.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24887.83},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18768.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8211.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25415.82},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8367.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":17430.58,"10th_percentile":17430.58,"90th_percentile":17430.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7934.41,"10th_percentile":7934.41,"90th_percentile":7934.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7482.81,"10th_percentile":7482.81,"90th_percentile":7482.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12571.77,"maximum":46277.15,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18140.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37611.39},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26292.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43981.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46277.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13326.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29795.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15086.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12571.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12571.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15086.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40232.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13200.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41085.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13451.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6686.42,"maximum":23200.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7020.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7154.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7154.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16047.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8977.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18613.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9777.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21765.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23200.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7087.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15846.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8023.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6686.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7154.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6686.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8023.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20169.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16047.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7020.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20597.71},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7154.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5953.69,"10th_percentile":5729.84,"90th_percentile":6323.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5782.83,"10th_percentile":5782.83,"90th_percentile":8126.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":17291.15,"10th_percentile":15396.4,"90th_percentile":20362.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6158.58,"10th_percentile":6158.58,"90th_percentile":7184.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":11569.51,"10th_percentile":7081.45,"90th_percentile":14926.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":7560.46,"10th_percentile":1664.2,"90th_percentile":12215.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6122.28,"10th_percentile":6122.28,"90th_percentile":6122.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"14","median_amount":18229.69,"10th_percentile":13800.72,"90th_percentile":19029.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8428.82,"10th_percentile":7770.27,"90th_percentile":9920.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":16660.32,"10th_percentile":16660.32,"90th_percentile":16660.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6360.78,"10th_percentile":6360.78,"90th_percentile":6360.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":1819.2,"10th_percentile":343.89,"90th_percentile":7128.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10761.38,"10th_percentile":10719.12,"90th_percentile":10935.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7035.58,"10th_percentile":7035.58,"90th_percentile":7035.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6682.57,"10th_percentile":6191.95,"90th_percentile":7361.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7142.91,"10th_percentile":7142.91,"90th_percentile":7142.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5519.98,"10th_percentile":1448.11,"90th_percentile":7756.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":15046.69,"10th_percentile":485.82,"90th_percentile":20636.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":5255.27,"10th_percentile":489.85,"90th_percentile":7024.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1871.75,"10th_percentile":1871.75,"90th_percentile":5015.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9805.15,"maximum":36307.19,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10295.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10491.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10491.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23532.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12558.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26036.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11905.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30446.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36307.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10393.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23238.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9805.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10491.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9805.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11766.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31564.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23532.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10295.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32234.16},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10491.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9179.01,"10th_percentile":512.62,"90th_percentile":9374.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":171.73,"10th_percentile":171.73,"90th_percentile":171.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":25884.12,"10th_percentile":25884.12,"90th_percentile":25884.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7871.31,"10th_percentile":518.48,"90th_percentile":10491.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19166.49,"10th_percentile":19166.49,"90th_percentile":22840.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12754.95,"10th_percentile":12754.95,"90th_percentile":12754.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8631.02,"10th_percentile":8132.43,"90th_percentile":9090.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":25437.12,"10th_percentile":22124.46,"90th_percentile":31709.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12149.05,"10th_percentile":9719.24,"90th_percentile":12149.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":416.16,"10th_percentile":416.16,"90th_percentile":416.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7696.96,"10th_percentile":7696.96,"90th_percentile":7696.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7616.27,"10th_percentile":417.63,"90th_percentile":9431.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16774.27,"10th_percentile":16774.27,"90th_percentile":18251.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7978.38,"10th_percentile":7978.38,"90th_percentile":7978.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9548.64,"10th_percentile":9119.22,"90th_percentile":10594.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9618.01,"10th_percentile":9618.01,"90th_percentile":9618.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7756.76,"10th_percentile":7756.76,"90th_percentile":7756.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":7480.51,"10th_percentile":2100.89,"90th_percentile":7993.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7992.68,"10th_percentile":7846.71,"90th_percentile":9427.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6099.11,"maximum":22179.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6404.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14637.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9148.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18967.02},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8223.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22179.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20780.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14454.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6099.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6099.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7318.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18066.04},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14637.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6404.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18449.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6526.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5929.37,"10th_percentile":5929.37,"90th_percentile":5929.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":19383.12,"10th_percentile":19383.12,"90th_percentile":19383.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4575.28,"10th_percentile":4575.28,"90th_percentile":4575.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10762.93,"10th_percentile":10762.93,"90th_percentile":10762.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5848.69,"10th_percentile":5848.69,"90th_percentile":5848.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1317.65,"10th_percentile":1317.65,"90th_percentile":1317.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9852.48,"maximum":35948.7,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23645.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12443.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9852.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25798.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11445.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30168.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35948.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10443.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23350.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11822.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9852.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9852.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11822.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31252.86},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23645.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10345.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31915.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":687.33,"10th_percentile":687.33,"90th_percentile":687.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6432.56,"maximum":26311.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15438.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10852.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22500.42},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8574.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26311.07},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22044.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6818.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15245.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7719.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6432.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6432.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7719.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19164.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15438.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6754.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19571.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":359.35,"10th_percentile":359.35,"90th_percentile":359.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21053.41,"10th_percentile":21053.41,"90th_percentile":21053.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":22844.98,"10th_percentile":21967.55,"90th_percentile":39197.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8774.04,"10th_percentile":7114.55,"90th_percentile":8817.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":8594.72,"10th_percentile":8594.72,"90th_percentile":8594.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":187.29,"10th_percentile":187.29,"90th_percentile":187.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6193.82,"10th_percentile":6193.82,"90th_percentile":6193.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":3843.97,"10th_percentile":3843.97,"90th_percentile":3843.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4996.23,"10th_percentile":4080.68,"90th_percentile":6036.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6205.67,"10th_percentile":6205.67,"90th_percentile":6205.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13179.16,"maximum":71105.46,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31629.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29328.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13179.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60807.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25974.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71105.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51376.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13969.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31234.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15814.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13179.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13179.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15814.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44665.36},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31629.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13838.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45612.93},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14101.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26819.37,"maximum":113339.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28160.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28696.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28696.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46748.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26819.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96924.42},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50294.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113339.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108278.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28428.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63561.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26819.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28696.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26819.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32183.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":94134.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64366.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28160.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96131.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28696.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":23979.31,"10th_percentile":23979.31,"90th_percentile":23979.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16092.08,"maximum":83328.77,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16896.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38620.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34370.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16092.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71260.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30230.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83328.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61130.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17057.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38138.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19310.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16092.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17218.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16092.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19310.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53144.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38620.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16896.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54272.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17218.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14164.0,"10th_percentile":14164.0,"90th_percentile":14164.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11047.9,"maximum":56402.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11821.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11821.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23263.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11047.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48233.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26929.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56402.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42346.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11710.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26183.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13257.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11047.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11821.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11047.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13257.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36814.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26514.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11600.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37595.55},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11821.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10069.88,"10th_percentile":10069.88,"90th_percentile":10069.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18384.69,"maximum":78244.57,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19303.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44123.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32273.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66912.37},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29903.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78244.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73445.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19487.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43571.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18384.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18384.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63851.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44123.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19303.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65206.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19671.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1585.26,"10th_percentile":1326.54,"90th_percentile":18240.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13419.21,"10th_percentile":13419.21,"90th_percentile":13419.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17678.77,"10th_percentile":17678.77,"90th_percentile":17678.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40880.85,"10th_percentile":40880.85,"90th_percentile":40880.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":32864.17,"10th_percentile":32864.17,"90th_percentile":32864.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17852.71,"10th_percentile":17852.71,"90th_percentile":17852.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"14","median_amount":66213.07,"10th_percentile":55795.68,"90th_percentile":68764.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":28353.5,"10th_percentile":28328.83,"90th_percentile":31902.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":731.82,"10th_percentile":731.82,"90th_percentile":731.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48932.37,"10th_percentile":43486.1,"90th_percentile":76366.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18674.85,"10th_percentile":18402.41,"90th_percentile":19851.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13314.69,"10th_percentile":13314.69,"90th_percentile":13314.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19424.9,"10th_percentile":19424.9,"90th_percentile":19839.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":474.14,"10th_percentile":474.14,"90th_percentile":474.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16427.26,"10th_percentile":15490.43,"90th_percentile":17907.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18274.81,"10th_percentile":18274.81,"90th_percentile":18274.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13402.19,"maximum":62651.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14072.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32165.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25841.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13402.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53577.51},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22631.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62651.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51255.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31763.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16082.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13402.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13402.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16082.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44560.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32165.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14072.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45505.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14340.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12229.45,"10th_percentile":12208.22,"90th_percentile":13292.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18720.73,"10th_percentile":18720.73,"90th_percentile":18720.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":42323.51,"10th_percentile":42323.51,"90th_percentile":42323.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13552.03,"10th_percentile":13139.11,"90th_percentile":13662.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25179.72,"10th_percentile":21696.92,"90th_percentile":30315.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":25663.07,"10th_percentile":21949.44,"90th_percentile":26445.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8533.01,"10th_percentile":8533.01,"90th_percentile":8533.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"21","median_amount":53636.39,"10th_percentile":49230.69,"90th_percentile":55969.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"17","median_amount":21725.75,"10th_percentile":20888.55,"90th_percentile":23844.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":57676.26,"10th_percentile":57676.26,"90th_percentile":64433.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52172.15,"10th_percentile":52172.15,"90th_percentile":52172.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14026.91,"10th_percentile":14026.91,"90th_percentile":14026.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24209.86,"10th_percentile":24209.86,"90th_percentile":24209.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10078.0,"10th_percentile":10078.0,"90th_percentile":10078.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14759.65,"10th_percentile":14759.65,"90th_percentile":17820.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":34732.79,"10th_percentile":31323.67,"90th_percentile":43949.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12759.13,"10th_percentile":12237.86,"90th_percentile":14376.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":2113.19,"10th_percentile":2113.19,"90th_percentile":2113.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15665.28,"10th_percentile":15665.28,"90th_percentile":15665.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":72380.61,"10th_percentile":72380.61,"90th_percentile":72380.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10833.73,"10th_percentile":10833.73,"90th_percentile":10833.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16815.02,"10th_percentile":16815.02,"90th_percentile":16815.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19255.72,"10th_percentile":11564.6,"90th_percentile":30167.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10161.65,"10th_percentile":10161.65,"90th_percentile":10161.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"21","median_amount":39186.32,"10th_percentile":36920.33,"90th_percentile":41202.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"15","median_amount":19790.11,"10th_percentile":18855.76,"90th_percentile":21040.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":46205.72,"10th_percentile":46205.72,"90th_percentile":46205.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9040.4,"10th_percentile":9040.4,"90th_percentile":9040.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33736.6,"10th_percentile":33736.6,"90th_percentile":33736.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10651.49,"10th_percentile":9879.96,"90th_percentile":10867.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21301.44,"10th_percentile":21301.44,"90th_percentile":21301.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9925.61,"10th_percentile":9925.61,"90th_percentile":9925.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10578.88,"10th_percentile":10578.88,"90th_percentile":10578.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11824.99,"10th_percentile":11824.99,"90th_percentile":11824.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":32784.02,"10th_percentile":32784.02,"90th_percentile":37075.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25704.26,"maximum":127657.96,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26989.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96834.19},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27503.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25653.13,"10th_percentile":25653.13,"90th_percentile":25653.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57691.06,"10th_percentile":57691.06,"90th_percentile":57691.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13731.34,"maximum":82625.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14417.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34080.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70658.79},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25772.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82625.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50606.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14555.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32543.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16477.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13731.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13731.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16477.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43996.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14417.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44929.73},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14692.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":483.82,"10th_percentile":483.82,"90th_percentile":483.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":34233.13,"10th_percentile":34233.13,"90th_percentile":34233.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":74599.47,"10th_percentile":74599.47,"90th_percentile":74599.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14738.56,"10th_percentile":14738.56,"90th_percentile":14738.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11307.5,"maximum":71178.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27138.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29358.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60869.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24201.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71178.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45408.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11985.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26798.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13569.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11307.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13569.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39477.15},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27138.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11872.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40314.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12099.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31053.21,"maximum":145027.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32605.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33226.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33226.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74527.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59818.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31053.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124023.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66163.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145027.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125693.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32916.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":73596.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37263.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31053.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33226.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31053.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37263.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":109274.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74527.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32605.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":111593.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33226.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":117236.38,"10th_percentile":117236.38,"90th_percentile":117236.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30001.31,"10th_percentile":30001.31,"90th_percentile":30001.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16961.22,"maximum":110269.87,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18148.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18148.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40706.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45482.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16961.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94299.43},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36045.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110269.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70559.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17978.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40198.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20353.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16961.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18148.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16961.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20353.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61342.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40706.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17809.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62643.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18148.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":34826.05,"10th_percentile":34826.05,"90th_percentile":34826.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12030.35,"maximum":94548.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12631.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12872.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12872.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38997.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80854.93},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27982.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94548.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47769.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12752.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28511.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14436.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12030.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12872.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14436.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41529.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28872.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12631.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42410.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12872.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. 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Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or 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Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53037.03,"maximum":219385.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55688.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56749.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56749.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":127288.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":99428.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53037.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112317.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76457.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":131339.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":219385.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56219.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":125697.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63644.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":53037.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56749.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53037.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63644.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":190727.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":127288.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55688.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":194774.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56749.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53870.51,"10th_percentile":53870.51,"90th_percentile":55005.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56721.87,"10th_percentile":56721.87,"90th_percentile":56721.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":119220.39,"10th_percentile":119220.39,"90th_percentile":119220.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":97286.91,"10th_percentile":97286.91,"90th_percentile":97286.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49873.89,"10th_percentile":49873.89,"90th_percentile":49873.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":116083.28,"10th_percentile":111556.49,"90th_percentile":117349.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":77942.98,"10th_percentile":2055.69,"90th_percentile":78514.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":223828.82,"10th_percentile":223828.82,"90th_percentile":223828.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55797.7,"10th_percentile":55797.7,"90th_percentile":55797.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":111223.75,"10th_percentile":111223.75,"90th_percentile":111223.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56852.97,"10th_percentile":56852.97,"90th_percentile":56852.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50262.44,"10th_percentile":49961.1,"90th_percentile":50664.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54219.63,"10th_percentile":54219.63,"90th_percentile":54219.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44136.91,"10th_percentile":44136.91,"90th_percentile":44136.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41587.6,"maximum":170138.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43666.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44498.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44498.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":99810.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":86152.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41587.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89500.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67470.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104658.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170138.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44082.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":98562.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49905.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":41587.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44498.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41587.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49905.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":147913.71},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":99810.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43666.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":151051.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44498.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39187.27,"10th_percentile":39187.27,"90th_percentile":39187.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":96757.45,"10th_percentile":96757.45,"90th_percentile":96757.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":69930.75,"10th_percentile":69930.75,"90th_percentile":69930.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":109601.37,"10th_percentile":109601.37,"90th_percentile":109601.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29466.1,"10th_percentile":29466.1,"90th_percentile":29466.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43512.0,"10th_percentile":43512.0,"90th_percentile":43512.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42571.11,"10th_percentile":42571.11,"90th_percentile":42571.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":158973.28,"10th_percentile":158973.28,"90th_percentile":158973.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39595.55,"10th_percentile":39595.55,"90th_percentile":41562.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65880.52,"maximum":257747.7,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70492.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70492.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":158113.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":127383.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65880.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136528.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100602.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159650.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":257747.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69833.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":156136.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79056.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":65880.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70492.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65880.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":79056.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":224079.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":158113.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":228832.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70492.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42628.13,"maximum":169053.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44759.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45612.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45612.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":102307.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":98100.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42628.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110036.88},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75557.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128672.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":169053.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45185.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101028.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51153.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":42628.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45612.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42628.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51153.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":146970.65},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":102307.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44759.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":150088.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45612.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":92838.62,"10th_percentile":92838.62,"90th_percentile":92838.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":114463.62,"10th_percentile":114463.62,"90th_percentile":115749.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":78887.85,"10th_percentile":78887.85,"90th_percentile":78887.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38299.89,"10th_percentile":38299.89,"90th_percentile":38299.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85655.24,"10th_percentile":85655.24,"90th_percentile":85655.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39474.44,"10th_percentile":39474.44,"90th_percentile":39474.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42998.48,"10th_percentile":42998.48,"90th_percentile":42998.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15385.72,"maximum":60545.99,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16462.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16462.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36925.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22712.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47090.2},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22595.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55065.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60545.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16308.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36464.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18462.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15385.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16462.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15385.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18462.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52637.1},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36925.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16155.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53753.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16462.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13846.49,"10th_percentile":13846.49,"90th_percentile":13846.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22274.6,"10th_percentile":22274.6,"90th_percentile":22274.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":24315.32,"10th_percentile":18435.49,"90th_percentile":37101.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8874.72,"10th_percentile":684.26,"90th_percentile":13477.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":35081.61,"10th_percentile":28150.24,"90th_percentile":35840.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"14","median_amount":22901.84,"10th_percentile":21373.34,"90th_percentile":30933.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13884.08,"10th_percentile":12941.77,"90th_percentile":14434.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":26268.03,"10th_percentile":349.66,"90th_percentile":64377.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23279.02,"10th_percentile":23266.12,"90th_percentile":46873.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":51424.05,"10th_percentile":51424.05,"90th_percentile":51424.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11515.79,"10th_percentile":11515.79,"90th_percentile":16988.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61516.74,"10th_percentile":39750.28,"90th_percentile":61946.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21387.98,"10th_percentile":21387.98,"90th_percentile":21387.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13507.13,"10th_percentile":12828.81,"90th_percentile":14960.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21840.46,"10th_percentile":21840.46,"90th_percentile":21977.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14522.15,"10th_percentile":327.7,"90th_percentile":15240.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9495.19,"10th_percentile":2187.64,"90th_percentile":21381.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":55671.37,"10th_percentile":46500.32,"90th_percentile":67466.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":14307.01,"10th_percentile":13100.57,"90th_percentile":15366.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":30031.61,"10th_percentile":30031.61,"90th_percentile":30031.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8845.65,"maximum":41871.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9464.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9464.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21229.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17270.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35807.09},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12174.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41871.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33059.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20964.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8845.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9464.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8845.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10614.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28740.7},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21229.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29350.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9464.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7066.69,"10th_percentile":6988.67,"90th_percentile":9325.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":17744.08,"10th_percentile":17744.08,"90th_percentile":42037.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8470.72,"10th_percentile":8470.72,"90th_percentile":8470.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21198.53,"10th_percentile":20378.23,"90th_percentile":21239.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23081.54,"10th_percentile":17467.27,"90th_percentile":44269.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8314.31,"10th_percentile":7377.51,"90th_percentile":8411.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":33070.77,"10th_percentile":33070.77,"90th_percentile":33070.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12374.22,"10th_percentile":12374.22,"90th_percentile":12877.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":24236.4,"10th_percentile":24236.4,"90th_percentile":24236.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9104.58,"10th_percentile":9104.58,"90th_percentile":9104.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31594.59,"10th_percentile":31594.59,"90th_percentile":31594.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7570.23,"10th_percentile":7570.23,"90th_percentile":7628.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10202.01,"10th_percentile":10202.01,"90th_percentile":10202.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8120.69,"10th_percentile":8120.69,"90th_percentile":8120.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8348.25,"10th_percentile":8348.25,"90th_percentile":8348.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9706.16,"10th_percentile":9706.16,"90th_percentile":9706.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8114.6,"10th_percentile":750.99,"90th_percentile":9323.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6380.93,"maximum":37087.51,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15314.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15297.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31716.11},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7535.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37087.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21522.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6763.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15122.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7657.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6380.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7657.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18710.88},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15314.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6699.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19107.82},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14442.72,"maximum":57365.68,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15453.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15453.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34662.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23661.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14442.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49057.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19616.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57365.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56386.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15309.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34229.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17331.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14442.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15453.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14442.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17331.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49020.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34662.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50060.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15453.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13730.08,"10th_percentile":13730.08,"90th_percentile":14909.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":41918.11,"10th_percentile":41918.11,"90th_percentile":41918.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12705.65,"10th_percentile":12705.65,"90th_percentile":12705.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23537.97,"10th_percentile":23098.75,"90th_percentile":23544.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13221.16,"10th_percentile":13221.16,"90th_percentile":13466.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":49663.02,"10th_percentile":17033.5,"90th_percentile":78343.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":19382.27,"10th_percentile":17799.93,"90th_percentile":21274.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":39982.15,"10th_percentile":39982.15,"90th_percentile":39982.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13507.44,"10th_percentile":704.23,"90th_percentile":15218.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27983.91,"10th_percentile":27983.91,"90th_percentile":27983.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13904.85,"10th_percentile":13904.85,"90th_percentile":13932.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13500.85,"10th_percentile":13284.13,"90th_percentile":15534.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":50798.98,"10th_percentile":50798.98,"90th_percentile":50798.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12766.57,"10th_percentile":12766.57,"90th_percentile":14099.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9382.77,"maximum":47274.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9851.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22518.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19498.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9382.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40427.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12110.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47274.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34848.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9945.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22237.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11259.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9382.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9382.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11259.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30296.36},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22518.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9851.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30939.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10039.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7244.8,"10th_percentile":7244.8,"90th_percentile":7244.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":26910.25,"10th_percentile":26910.25,"90th_percentile":26910.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10082.38,"10th_percentile":10082.38,"90th_percentile":10082.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10814.18,"10th_percentile":10814.18,"90th_percentile":10814.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19647.3,"10th_percentile":19647.3,"90th_percentile":19647.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8980.25,"10th_percentile":8980.25,"90th_percentile":8980.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":41518.59,"10th_percentile":34034.11,"90th_percentile":50655.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13491.14,"10th_percentile":13491.14,"90th_percentile":13491.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7781.72,"10th_percentile":7781.72,"90th_percentile":7781.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15791.33,"10th_percentile":15791.33,"90th_percentile":15791.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9919.39,"10th_percentile":9919.39,"90th_percentile":9919.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8887.31,"10th_percentile":8887.31,"90th_percentile":8887.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7390.63,"maximum":42889.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17737.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17690.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36677.92},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14308.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42889.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24263.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7834.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17515.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7390.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8868.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21094.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17737.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7760.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21541.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7907.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18286.92,"10th_percentile":18286.92,"90th_percentile":18286.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":37094.02,"10th_percentile":37094.02,"90th_percentile":37094.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12961.88,"maximum":52017.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13609.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31108.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21455.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12961.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44483.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16592.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52017.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51419.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13739.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30719.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12961.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12961.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44702.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31108.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13609.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45651.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13869.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12538.88,"10th_percentile":12538.88,"90th_percentile":12538.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2794.05,"10th_percentile":2794.05,"90th_percentile":11536.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29310.85,"10th_percentile":23794.07,"90th_percentile":29947.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":20698.07,"10th_percentile":17912.51,"90th_percentile":49673.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"12","median_amount":43105.6,"10th_percentile":22891.63,"90th_percentile":53408.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14564.71,"10th_percentile":13926.51,"90th_percentile":17489.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21573.09,"10th_percentile":21573.09,"90th_percentile":21573.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7040.3,"10th_percentile":7040.3,"90th_percentile":7040.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11148.59,"10th_percentile":10403.83,"90th_percentile":13115.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26234.55,"10th_percentile":26234.55,"90th_percentile":26234.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12477.49,"10th_percentile":12434.01,"90th_percentile":13299.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4457.6,"10th_percentile":4457.6,"90th_percentile":4457.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11207.96,"10th_percentile":11207.96,"90th_percentile":11207.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":45027.28,"10th_percentile":45027.28,"90th_percentile":45027.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10728.19,"10th_percentile":610.78,"90th_percentile":12506.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11904.8,"10th_percentile":11904.8,"90th_percentile":13765.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7303.86,"maximum":38860.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7669.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16028.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33232.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10991.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38860.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26584.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17310.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8764.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7303.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7303.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8764.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23111.85},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17529.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7669.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23602.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7101.64,"10th_percentile":7101.64,"90th_percentile":7101.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6164.05,"10th_percentile":4930.91,"90th_percentile":7287.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16927.95,"10th_percentile":16927.95,"90th_percentile":18137.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16225.35,"10th_percentile":13784.16,"90th_percentile":38587.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6861.86,"10th_percentile":6861.86,"90th_percentile":6861.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"19","median_amount":24376.75,"10th_percentile":17078.69,"90th_percentile":44435.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10273.9,"10th_percentile":10273.9,"90th_percentile":10273.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24411.07,"10th_percentile":18775.14,"90th_percentile":25994.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2737.25,"10th_percentile":575.87,"90th_percentile":7253.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14020.87,"10th_percentile":14020.87,"90th_percentile":14020.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7255.18,"10th_percentile":6960.8,"90th_percentile":7946.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7499.35,"10th_percentile":7499.35,"90th_percentile":7499.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11179.62,"10th_percentile":11179.62,"90th_percentile":11179.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":12839.54,"10th_percentile":1066.61,"90th_percentile":23578.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6541.53,"10th_percentile":5264.6,"90th_percentile":7618.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":23422.4,"10th_percentile":23422.4,"90th_percentile":23422.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5727.64,"maximum":19585.87,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6014.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6128.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6128.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13746.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13464.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16749.24},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7914.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19585.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19009.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6071.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13574.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6873.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5727.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6128.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5727.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6873.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16526.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13746.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6014.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16877.11},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6128.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5824.34,"10th_percentile":5824.34,"90th_percentile":5824.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5427.1,"10th_percentile":5427.1,"90th_percentile":5427.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11087.5,"10th_percentile":11087.5,"90th_percentile":12934.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12554.07,"10th_percentile":10404.92,"90th_percentile":13656.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":13840.53,"10th_percentile":6659.11,"90th_percentile":20435.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8113.99,"10th_percentile":8113.99,"90th_percentile":8113.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":16414.59,"10th_percentile":16414.59,"90th_percentile":16414.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7244.54,"10th_percentile":7244.54,"90th_percentile":7244.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5008.17,"10th_percentile":5008.17,"90th_percentile":5008.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8381.34,"10th_percentile":8381.34,"90th_percentile":8381.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7326.97,"10th_percentile":7326.97,"90th_percentile":7326.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":18022.1,"10th_percentile":18022.1,"90th_percentile":18022.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5535.08,"10th_percentile":5535.08,"90th_percentile":5535.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":310.55,"10th_percentile":310.55,"90th_percentile":310.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14141.53,"maximum":58419.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14848.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15131.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15131.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33939.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21111.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14141.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30243.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19070.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35365.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58419.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14990.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33515.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14141.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15131.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14141.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16969.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50788.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33939.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14848.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51866.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15131.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13187.06,"10th_percentile":12927.66,"90th_percentile":14129.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":52753.02,"10th_percentile":52753.02,"90th_percentile":52753.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31767.48,"10th_percentile":29094.56,"90th_percentile":34087.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21491.43,"10th_percentile":21307.83,"90th_percentile":58692.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13245.23,"10th_percentile":13049.63,"90th_percentile":13464.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":33930.44,"10th_percentile":33930.44,"90th_percentile":33930.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":19766.99,"10th_percentile":19270.34,"90th_percentile":19778.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21208.35,"10th_percentile":21208.35,"90th_percentile":21208.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25388.88,"10th_percentile":25388.88,"90th_percentile":25388.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13399.16,"10th_percentile":12261.31,"90th_percentile":15283.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14399.86,"10th_percentile":14399.86,"90th_percentile":14399.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16167.42,"10th_percentile":16167.42,"90th_percentile":16167.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9612.37,"10th_percentile":9612.37,"90th_percentile":9612.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":14103.07,"10th_percentile":12153.54,"90th_percentile":14715.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12067.87,"10th_percentile":12067.87,"90th_percentile":12067.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8193.79,"maximum":40054.51,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8603.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16521.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34253.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9898.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40054.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29860.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8685.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19419.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8193.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8193.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9832.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25959.86},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19665.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8603.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26510.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8767.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6441.16,"10th_percentile":6441.16,"90th_percentile":7768.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6276.28,"10th_percentile":6276.28,"90th_percentile":6276.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7625.52,"10th_percentile":7625.52,"90th_percentile":7625.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16761.52,"10th_percentile":16761.52,"90th_percentile":16761.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7587.27,"10th_percentile":7587.27,"90th_percentile":7587.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":27379.08,"10th_percentile":23015.23,"90th_percentile":44936.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10079.02,"10th_percentile":9696.09,"90th_percentile":10562.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7554.24,"10th_percentile":7090.16,"90th_percentile":8183.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9678.14,"10th_percentile":9678.14,"90th_percentile":9678.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6319.64,"10th_percentile":6319.64,"90th_percentile":6319.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":27114.67,"10th_percentile":27114.67,"90th_percentile":27114.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7346.61,"10th_percentile":665.19,"90th_percentile":8045.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17205.33,"10th_percentile":17205.33,"90th_percentile":17205.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6643.92,"10th_percentile":6643.92,"90th_percentile":6643.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6289.14,"maximum":33256.05,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15093.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13716.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6289.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28439.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8340.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33256.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21713.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6666.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14905.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7546.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6289.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6729.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6289.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7546.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18877.46},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15093.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6603.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19277.94},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6729.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10068.76,"10th_percentile":10068.76,"90th_percentile":10068.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5833.31,"10th_percentile":5833.31,"90th_percentile":5833.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":22748.08,"10th_percentile":22748.08,"90th_percentile":22748.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":13220.36,"10th_percentile":13220.36,"90th_percentile":13220.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6751.47,"10th_percentile":6751.47,"90th_percentile":6751.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11489.4,"10th_percentile":11489.4,"90th_percentile":11489.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13253.74,"maximum":52059.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13916.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14181.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14181.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31808.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20765.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43052.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17234.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50343.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52059.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14048.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31411.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13253.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14181.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15904.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45259.15},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31808.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13916.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46219.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14181.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":25895.88,"10th_percentile":25895.88,"90th_percentile":25895.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13263.57,"10th_percentile":13134.55,"90th_percentile":29673.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24324.76,"10th_percentile":24324.76,"90th_percentile":24324.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12718.63,"10th_percentile":12718.63,"90th_percentile":12718.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":46965.1,"10th_percentile":30342.31,"90th_percentile":64084.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":18124.39,"10th_percentile":18124.39,"90th_percentile":18124.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":56487.07,"10th_percentile":56487.07,"90th_percentile":56487.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12040.85,"10th_percentile":6048.65,"90th_percentile":13970.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25154.55,"10th_percentile":25154.55,"90th_percentile":25154.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13062.88,"10th_percentile":13062.88,"90th_percentile":13062.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13002.68,"10th_percentile":13002.68,"90th_percentile":13947.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":50160.86,"10th_percentile":50160.86,"90th_percentile":50160.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9119.59,"maximum":40402.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21887.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16664.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9119.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34550.98},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14200.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40402.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33513.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21613.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9119.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9119.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29135.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21887.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9575.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29753.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8898.06,"10th_percentile":8898.06,"90th_percentile":8898.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8401.4,"10th_percentile":8401.4,"90th_percentile":8401.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6847.45,"10th_percentile":6771.78,"90th_percentile":8827.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19736.19,"10th_percentile":19736.19,"90th_percentile":19736.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12720.14,"10th_percentile":12720.14,"90th_percentile":17055.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8969.77,"10th_percentile":8969.77,"90th_percentile":8969.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30008.49,"10th_percentile":30008.49,"90th_percentile":35569.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14400.59,"10th_percentile":13253.28,"90th_percentile":34458.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8244.68,"10th_percentile":365.04,"90th_percentile":9916.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9307.33,"10th_percentile":9307.33,"90th_percentile":9307.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8711.34,"10th_percentile":8711.34,"90th_percentile":8711.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9196.66,"10th_percentile":9196.66,"90th_percentile":9196.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":19699.51,"10th_percentile":19699.51,"90th_percentile":19699.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8548.1,"10th_percentile":809.97,"90th_percentile":10888.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7204.18,"maximum":31212.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7708.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7708.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17290.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12873.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26691.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10853.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31212.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24637.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7636.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17073.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8645.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7204.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7708.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7204.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8645.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21419.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17290.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7564.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21873.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7708.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15865.41,"10th_percentile":15865.41,"90th_percentile":15865.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9592.36,"10th_percentile":9592.36,"90th_percentile":9592.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":25347.34,"10th_percentile":25347.34,"90th_percentile":25347.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10295.73,"10th_percentile":10295.73,"90th_percentile":11536.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6984.79,"10th_percentile":6984.79,"90th_percentile":6984.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1221.43,"10th_percentile":1221.43,"90th_percentile":1221.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":20226.04,"10th_percentile":20226.04,"90th_percentile":20226.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5834.73,"10th_percentile":5834.73,"90th_percentile":6327.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49186.13,"maximum":207193.3,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51645.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52629.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52629.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":118046.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":73546.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49186.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":152484.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88886.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":178309.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":207193.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52137.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":116571.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59023.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":49186.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52629.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49186.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59023.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":180128.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":118046.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51645.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":183949.84},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52629.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":93855.74,"10th_percentile":93855.74,"90th_percentile":93855.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49919.91,"10th_percentile":49919.91,"90th_percentile":49919.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":77771.6,"10th_percentile":77771.6,"90th_percentile":77771.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":130026.16,"10th_percentile":130026.16,"90th_percentile":130026.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1313.45,"10th_percentile":1313.45,"90th_percentile":1313.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31682.83,"maximum":127727.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33266.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33900.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33900.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":76038.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52683.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109228.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53382.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127727.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":126191.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33583.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75088.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38019.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31682.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33900.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31682.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38019.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":109707.42},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":76038.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33266.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":112034.84},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33900.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30405.26,"10th_percentile":30405.26,"90th_percentile":30405.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":69342.12,"10th_percentile":69342.12,"90th_percentile":69342.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":56162.72,"10th_percentile":56162.72,"90th_percentile":56162.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29143.98,"10th_percentile":29143.98,"90th_percentile":30017.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":115524.46,"10th_percentile":115524.46,"90th_percentile":115524.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":55274.55,"10th_percentile":55274.55,"90th_percentile":73709.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":45575.7,"10th_percentile":45575.7,"90th_percentile":45575.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30588.09,"10th_percentile":30333.61,"90th_percentile":32136.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29902.55,"10th_percentile":29902.55,"90th_percentile":29902.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30846.65,"10th_percentile":30846.65,"90th_percentile":32979.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39490.76,"maximum":169708.79,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41465.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42255.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42255.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":94777.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee 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Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24437.12,"maximum":127727.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee 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schedule","standard_charge_dollar":109228.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53382.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127727.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95366.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25903.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57915.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29324.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24437.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26147.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24437.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29324.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":82909.27},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58649.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25658.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84668.18},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26147.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":53070.82,"10th_percentile":53070.82,"90th_percentile":53070.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21279.02,"10th_percentile":21279.02,"90th_percentile":22136.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":121061.81,"10th_percentile":112958.16,"90th_percentile":151895.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":53779.21,"10th_percentile":53413.5,"90th_percentile":55298.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":93952.12,"10th_percentile":93952.12,"90th_percentile":93952.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24540.8,"10th_percentile":24540.8,"90th_percentile":26376.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48345.12,"10th_percentile":48345.12,"90th_percentile":48345.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25239.94,"10th_percentile":22505.61,"90th_percentile":25548.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":85438.09,"10th_percentile":85438.09,"90th_percentile":85438.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24949.7,"10th_percentile":24949.7,"90th_percentile":24949.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":61533.38,"maximum":261722.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64610.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65840.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65840.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":147680.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":102237.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61533.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211970.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":114684.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":247869.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":261722.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65225.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":145834.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73840.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":61533.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65840.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61533.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":73840.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":227534.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":147680.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":64610.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":232361.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":65840.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":171042.5,"10th_percentile":171042.5,"90th_percentile":171042.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61829.56,"10th_percentile":61829.56,"90th_percentile":61829.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44033.67,"maximum":200180.98,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47116.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47116.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105680.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82567.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44033.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171188.67},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91100.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":200180.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":177363.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46675.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":104359.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52840.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":44033.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47116.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44033.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52840.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":154195.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105680.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":157466.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47116.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39952.09,"10th_percentile":39952.09,"90th_percentile":39952.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78142.78,"10th_percentile":78142.78,"90th_percentile":78142.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":195974.75,"10th_percentile":195974.75,"90th_percentile":195974.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":95476.35,"10th_percentile":95476.35,"90th_percentile":95476.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45339.07,"10th_percentile":45339.07,"90th_percentile":45339.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":156485.24,"10th_percentile":156485.24,"90th_percentile":156485.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31193.76,"maximum":181085.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32753.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33377.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33377.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74865.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74691.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31193.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154859.18},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75370.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181085.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133438.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33065.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":73929.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37432.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31193.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33377.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31193.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37432.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":116007.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74865.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32753.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":118469.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33377.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":77507.24,"10th_percentile":77507.24,"90th_percentile":77507.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40877.66,"maximum":189654.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42921.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43739.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43739.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":98106.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57933.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40877.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":120113.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119169.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140456.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":189654.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43330.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":96880.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49053.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":40877.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43739.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40877.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49053.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":164880.86},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":98106.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42921.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":168378.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43739.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20346.71,"maximum":113526.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21364.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48832.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46825.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20346.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97084.18},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42244.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113526.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88499.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21567.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48221.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20346.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20346.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24416.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":76939.2},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48832.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21364.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78571.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21770.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42143.36,"maximum":166908.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44250.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45093.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45093.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101144.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59852.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42143.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124092.2},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72834.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145108.32},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166908.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44671.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":99879.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50572.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":42143.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45093.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42143.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50572.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":145106.01},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101144.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44250.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":148184.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45093.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":2159.63,"10th_percentile":2159.63,"90th_percentile":2159.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23607.42,"maximum":105570.29,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24787.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25259.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25259.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56657.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43544.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23607.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90280.49},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42035.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105570.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91126.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25023.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55949.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28328.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23607.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25259.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23607.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28328.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":79222.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56657.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24787.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80903.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25259.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20045.07,"10th_percentile":20045.07,"90th_percentile":20045.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20287.57,"10th_percentile":20287.57,"90th_percentile":20287.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52016.82,"10th_percentile":52016.82,"90th_percentile":52016.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21561.89,"10th_percentile":21561.89,"90th_percentile":21709.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":74169.06,"10th_percentile":74169.06,"90th_percentile":74169.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14349.49,"maximum":85775.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34438.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35379.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14349.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73352.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24268.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85775.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53647.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34008.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17219.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14349.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14349.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17219.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46640.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34438.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47629.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13533.45,"10th_percentile":13533.45,"90th_percentile":13533.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13548.74,"10th_percentile":13548.74,"90th_percentile":13548.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38600.11,"maximum":157439.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40530.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41302.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41302.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":92640.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53495.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38600.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110913.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55573.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129698.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":157439.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40916.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":91482.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46320.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":38600.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41302.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38600.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46320.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":136873.65},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":92640.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40530.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":139777.4},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41302.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38091.1,"10th_percentile":38091.1,"90th_percentile":38091.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39492.4,"10th_percentile":39492.4,"90th_percentile":39492.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36791.6,"10th_percentile":36791.6,"90th_percentile":36791.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26561.21,"maximum":105846.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27889.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28420.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28420.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41582.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26561.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86214.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43466.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100815.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":105846.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28154.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62950.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31873.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26561.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28420.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26561.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31873.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":92020.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27889.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":93972.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28420.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25087.86,"10th_percentile":25087.86,"90th_percentile":25087.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25796.92,"10th_percentile":25796.92,"90th_percentile":25796.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44988.5,"10th_percentile":44988.5,"90th_percentile":58409.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23710.81,"10th_percentile":23710.81,"90th_percentile":23710.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":87804.29,"10th_percentile":87804.29,"90th_percentile":87833.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":42873.59,"10th_percentile":42873.59,"90th_percentile":42873.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17264.14,"10th_percentile":17264.14,"90th_percentile":17264.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18338.71,"10th_percentile":18338.71,"90th_percentile":18338.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25178.47,"10th_percentile":25178.47,"90th_percentile":25488.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25030.65,"10th_percentile":23991.06,"90th_percentile":27561.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20977.77,"maximum":89907.45,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22026.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22446.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22446.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50346.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37083.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20977.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76886.11},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36305.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89907.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81070.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22236.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49717.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20977.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22446.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20977.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25173.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":70480.14},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50346.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22026.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71975.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22446.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":147053.03,"10th_percentile":147053.03,"90th_percentile":147053.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19920.37,"10th_percentile":19920.37,"90th_percentile":19920.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45267.14,"10th_percentile":45267.14,"90th_percentile":45267.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":37656.69,"10th_percentile":37656.69,"90th_percentile":37656.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19235.27,"10th_percentile":19235.27,"90th_percentile":19418.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":75353.67,"10th_percentile":67336.65,"90th_percentile":79460.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":36658.3,"10th_percentile":36031.78,"90th_percentile":37319.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63752.01,"10th_percentile":63752.01,"90th_percentile":63752.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6420.73,"10th_percentile":6420.73,"90th_percentile":6420.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22168.44,"10th_percentile":19761.79,"90th_percentile":23432.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19205.68,"10th_percentile":19088.73,"90th_percentile":21600.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20718.06,"10th_percentile":20718.06,"90th_percentile":20718.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":70163.56,"10th_percentile":70163.56,"90th_percentile":70163.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19082.39,"10th_percentile":17668.21,"90th_percentile":19725.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23022.97,"maximum":101012.99,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24174.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24634.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24634.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40285.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23022.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83523.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44649.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97669.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101012.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24404.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54564.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27627.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23022.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24634.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23022.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27627.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":87818.06},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55255.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24174.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89681.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24634.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24742.14,"10th_percentile":24742.14,"90th_percentile":24742.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23648.51,"10th_percentile":23648.51,"90th_percentile":23648.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":87194.52,"10th_percentile":87194.52,"90th_percentile":87194.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23815.57,"10th_percentile":23815.57,"90th_percentile":23815.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21526.64,"10th_percentile":21526.64,"90th_percentile":21526.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24550.05,"10th_percentile":24550.05,"90th_percentile":24550.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15103.89,"maximum":72786.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15859.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16161.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16161.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34749.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62245.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26063.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72786.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58271.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16010.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35796.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18124.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15103.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16161.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18124.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50659.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36249.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15859.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51734.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16161.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15693.89,"10th_percentile":15693.89,"90th_percentile":15693.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14898.94,"10th_percentile":14898.94,"90th_percentile":14968.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33541.6,"10th_percentile":33541.6,"90th_percentile":33541.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":35092.56,"10th_percentile":35092.56,"90th_percentile":35092.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14625.45,"10th_percentile":14625.45,"90th_percentile":14625.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":64393.53,"10th_percentile":63522.18,"90th_percentile":64435.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":24923.46,"10th_percentile":24923.46,"90th_percentile":25289.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":68474.64,"10th_percentile":68474.64,"90th_percentile":68474.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14295.41,"10th_percentile":13417.08,"90th_percentile":17425.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14203.14,"10th_percentile":14203.14,"90th_percentile":14203.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14687.75,"10th_percentile":14687.75,"90th_percentile":14687.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5336.43,"10th_percentile":5336.43,"90th_percentile":5336.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14346.35,"10th_percentile":13815.09,"90th_percentile":14489.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35898.74,"maximum":150105.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37693.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38411.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38411.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":86156.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52461.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35898.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108768.23},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63176.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127189.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":150105.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38052.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":85080.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43078.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":35898.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38411.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35898.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43078.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":130497.88},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":86156.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37693.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":133266.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38411.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35587.68,"10th_percentile":35587.68,"90th_percentile":35587.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":51852.93,"10th_percentile":51852.93,"90th_percentile":51852.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38072.24,"10th_percentile":38072.24,"90th_percentile":38072.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34499.32,"10th_percentile":34499.32,"90th_percentile":34499.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33310.03,"10th_percentile":33310.03,"90th_percentile":33310.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22398.37,"maximum":90911.1,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23518.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53756.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37497.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22398.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77744.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39833.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90911.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89531.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23742.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53084.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26878.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22398.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22398.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26878.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":77836.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53756.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23518.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79487.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21429.45,"10th_percentile":21352.31,"90th_percentile":21551.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22337.23,"10th_percentile":22337.23,"90th_percentile":24289.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55239.18,"10th_percentile":55239.18,"90th_percentile":55239.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":36940.14,"10th_percentile":29908.16,"90th_percentile":46708.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20342.89,"10th_percentile":20342.89,"90th_percentile":20342.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"15","median_amount":81296.29,"10th_percentile":79262.2,"90th_percentile":84370.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":40563.09,"10th_percentile":39484.73,"90th_percentile":42101.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":94209.93,"10th_percentile":94209.93,"90th_percentile":94209.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85479.22,"10th_percentile":85479.22,"90th_percentile":85479.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21863.71,"10th_percentile":20688.05,"90th_percentile":22996.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44865.9,"10th_percentile":44865.9,"90th_percentile":44865.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":46723.58,"10th_percentile":46723.58,"90th_percentile":46723.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22017.41,"10th_percentile":21679.68,"90th_percentile":22058.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":35819.73,"10th_percentile":35819.73,"90th_percentile":35819.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":81425.33,"10th_percentile":81425.33,"90th_percentile":81425.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":21523.45,"10th_percentile":20871.75,"90th_percentile":23729.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19886.59,"10th_percentile":19886.59,"90th_percentile":19886.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18778.38,"maximum":73158.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19717.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20092.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20092.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45068.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29379.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18778.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60913.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35224.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71230.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73158.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19905.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44504.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22534.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18778.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20092.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18778.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22534.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63601.93},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45068.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19717.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64951.23},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20092.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20212.72,"10th_percentile":20212.72,"90th_percentile":20212.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":35643.65,"10th_percentile":35643.65,"90th_percentile":35643.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17644.19,"10th_percentile":17644.19,"90th_percentile":17644.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":63542.26,"10th_percentile":61860.16,"90th_percentile":70958.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":35635.63,"10th_percentile":35635.63,"90th_percentile":36888.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16522.84,"10th_percentile":16522.84,"90th_percentile":16522.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39371.13,"10th_percentile":39371.13,"90th_percentile":39371.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19657.75,"10th_percentile":19657.75,"90th_percentile":19657.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17105.73,"10th_percentile":17105.73,"90th_percentile":17105.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1717.8,"10th_percentile":1717.8,"90th_percentile":1717.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19061.44,"10th_percentile":19061.44,"90th_percentile":19061.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32056.45,"maximum":138590.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33659.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34300.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34300.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":76935.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42956.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32056.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89061.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38641.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104145.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":138590.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33979.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75973.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38467.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":32056.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34300.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32056.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38467.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":120486.86},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":76935.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33659.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":123042.97},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34300.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31161.18,"10th_percentile":31161.18,"90th_percentile":31161.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":42657.8,"10th_percentile":42657.8,"90th_percentile":42657.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":38697.37,"10th_percentile":38697.37,"90th_percentile":38697.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31744.01,"10th_percentile":31744.01,"90th_percentile":31744.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32623.78,"10th_percentile":32623.78,"90th_percentile":35674.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17590.84,"maximum":78050.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18470.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18822.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18822.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42218.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32193.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17590.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66746.35},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23102.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78050.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66665.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18646.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41690.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17590.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18822.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17590.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21109.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57956.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42218.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18470.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59186.51},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18822.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11482.01,"10th_percentile":11482.01,"90th_percentile":11482.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":66582.85,"10th_percentile":66582.85,"90th_percentile":66582.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":24260.95,"10th_percentile":24260.95,"90th_percentile":24260.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16737.07,"10th_percentile":16737.07,"90th_percentile":16737.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22091.99,"10th_percentile":22091.99,"90th_percentile":22091.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16179.27,"10th_percentile":16179.27,"90th_percentile":16179.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9734.87,"maximum":61534.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10221.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23363.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25380.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52622.11},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20565.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61534.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35942.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10318.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23071.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11681.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11681.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31247.48},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23363.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10221.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31910.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10416.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44911.78,"10th_percentile":44911.78,"90th_percentile":44911.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9187.47,"10th_percentile":9187.47,"90th_percentile":9187.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26044.89,"maximum":106276.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27347.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27868.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27868.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62507.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40120.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26044.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83182.34},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35384.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97270.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106276.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27607.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":61726.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31253.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26044.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27868.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26044.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31253.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":92393.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62507.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27347.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94353.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27868.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1341.06,"10th_percentile":1341.06,"90th_percentile":1341.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18906.75,"maximum":72658.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19852.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45376.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29969.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62135.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26013.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72658.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72268.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20041.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44809.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22688.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18906.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22688.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62828.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45376.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19852.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64161.02},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20230.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":30150.28,"10th_percentile":30150.28,"90th_percentile":30150.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":70451.34,"10th_percentile":70451.34,"90th_percentile":70451.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":25677.74,"10th_percentile":25677.74,"90th_percentile":25677.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19826.77,"10th_percentile":19826.77,"90th_percentile":19826.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16047.34,"10th_percentile":16047.34,"90th_percentile":16047.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14601.92,"maximum":61479.19,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":51852.52,"10th_percentile":51852.52,"90th_percentile":51852.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22155.98,"maximum":90891.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23263.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23706.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23706.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53174.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36301.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22155.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75263.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46259.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88010.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90891.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23485.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52509.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26587.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22155.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23706.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22155.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26587.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":79018.79},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53174.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23263.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80695.16},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23706.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21834.51,"10th_percentile":21749.15,"90th_percentile":23003.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23582.69,"10th_percentile":23582.69,"90th_percentile":23582.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20206.1,"10th_percentile":1504.56,"90th_percentile":22590.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":97234.04,"10th_percentile":97234.04,"90th_percentile":97234.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19916.67,"10th_percentile":19916.67,"90th_percentile":19916.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80221.81,"10th_percentile":80221.81,"90th_percentile":92650.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":21478.22,"10th_percentile":19632.86,"90th_percentile":23410.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21647.53,"10th_percentile":21647.53,"90th_percentile":22859.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24513.09,"10th_percentile":24513.09,"90th_percentile":24513.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":21609.36,"10th_percentile":20337.23,"90th_percentile":23021.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22125.43,"10th_percentile":22125.43,"90th_percentile":22125.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16291.43,"maximum":67709.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17106.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17431.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17431.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39099.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27927.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16291.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57903.43},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33824.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67709.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64124.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17268.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38610.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16291.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17431.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16291.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19549.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":55748.41},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39099.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17106.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56931.11},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17431.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":15425.32,"10th_percentile":13862.63,"90th_percentile":15633.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":2747.54,"10th_percentile":2747.54,"90th_percentile":2747.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16061.65,"10th_percentile":14148.52,"90th_percentile":17489.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37323.95,"10th_percentile":37323.95,"90th_percentile":37323.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":27790.73,"10th_percentile":27790.73,"90th_percentile":27790.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":15417.2,"10th_percentile":15281.56,"90th_percentile":15987.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":58693.12,"10th_percentile":57256.76,"90th_percentile":108798.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":33420.26,"10th_percentile":33420.26,"90th_percentile":33420.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14757.69,"10th_percentile":14757.69,"90th_percentile":14757.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":58060.59,"10th_percentile":58060.59,"90th_percentile":58060.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":15817.09,"10th_percentile":13605.96,"90th_percentile":16100.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31464.55,"10th_percentile":31464.55,"90th_percentile":31464.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22191.09,"10th_percentile":22191.09,"90th_percentile":22191.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15973.89,"10th_percentile":15680.17,"90th_percentile":16447.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14948.81,"10th_percentile":14948.81,"90th_percentile":14948.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18089.36,"10th_percentile":18089.36,"90th_percentile":18089.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21561.1,"10th_percentile":21561.1,"90th_percentile":22936.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":15609.85,"10th_percentile":14372.44,"90th_percentile":16241.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":57173.92,"10th_percentile":57173.92,"90th_percentile":57173.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12967.61,"maximum":57303.41,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13615.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13875.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13875.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31122.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23635.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12967.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49004.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24626.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57303.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49027.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13745.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30733.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15561.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12967.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13875.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12967.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15561.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42623.4},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31122.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13615.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43527.64},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13875.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12033.91,"10th_percentile":12033.91,"90th_percentile":12033.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12485.2,"10th_percentile":12485.2,"90th_percentile":12485.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24338.44,"10th_percentile":24338.44,"90th_percentile":24338.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":464.28,"10th_percentile":464.28,"90th_percentile":464.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":56581.12,"10th_percentile":56581.12,"90th_percentile":56581.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":56080.21,"10th_percentile":56080.21,"90th_percentile":56080.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41930.26,"10th_percentile":41930.26,"90th_percentile":41930.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12219.86,"10th_percentile":10527.74,"90th_percentile":12434.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21149.16,"maximum":78749.03,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22206.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50757.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27207.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56409.25},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35480.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65962.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78749.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50123.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25378.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21149.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22629.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21149.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25378.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":68462.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50757.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22206.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69914.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22629.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19050.08,"10th_percentile":19050.08,"90th_percentile":19050.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19908.61,"10th_percentile":19908.61,"90th_percentile":19908.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44091.15,"10th_percentile":44091.15,"90th_percentile":44091.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":57342.52,"10th_percentile":57342.52,"90th_percentile":57342.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20695.61,"10th_percentile":20695.61,"90th_percentile":20695.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":56381.71,"10th_percentile":56381.71,"90th_percentile":56381.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":34736.86,"10th_percentile":34736.86,"90th_percentile":34736.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17794.5,"10th_percentile":17794.5,"90th_percentile":19510.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22959.97,"10th_percentile":22959.97,"90th_percentile":22959.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19055.88,"10th_percentile":17186.03,"90th_percentile":21641.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24413.46,"maximum":107551.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58592.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44361.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24413.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91975.14},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34778.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107551.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99625.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25878.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57859.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29296.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24413.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24413.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29296.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":86611.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58592.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":88449.14},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26122.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25984.04,"10th_percentile":25984.04,"90th_percentile":25984.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16267.05,"maximum":85647.42,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17080.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39040.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35326.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16267.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73243.06},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24392.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85647.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65540.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17243.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38552.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16267.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16267.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19520.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56978.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39040.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17080.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58187.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17405.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":63320.56,"10th_percentile":63320.56,"90th_percentile":63320.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14409.97,"10th_percentile":14409.97,"90th_percentile":14409.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12502.93,"maximum":65094.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30007.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26849.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12502.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55666.86},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19488.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65094.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48832.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13253.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29631.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15003.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12502.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12502.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15003.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42454.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30007.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13128.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43354.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13378.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":532.58,"10th_percentile":532.58,"90th_percentile":532.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11863.73,"10th_percentile":11863.73,"90th_percentile":11863.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13956.51,"maximum":60746.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14654.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33495.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25055.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13956.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51948.63},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37157.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60746.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60737.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14793.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33076.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13956.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13956.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52803.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33495.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14654.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53923.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14933.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44505.99,"10th_percentile":44505.99,"90th_percentile":44505.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9280.22,"maximum":53156.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9744.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22272.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21925.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45458.19},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20440.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53156.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38278.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9837.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21994.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11136.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11136.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33278.7},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22272.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9744.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33984.71},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9683.1,"10th_percentile":9683.1,"90th_percentile":9683.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10167.02,"10th_percentile":10167.02,"90th_percentile":10167.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22871.76,"10th_percentile":22871.76,"90th_percentile":22871.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":33327.44,"10th_percentile":33327.44,"90th_percentile":33327.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":43151.48,"10th_percentile":43151.48,"90th_percentile":43151.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27601.02,"maximum":109743.66,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29533.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29533.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66242.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33862.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27601.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70207.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55049.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82098.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109743.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29257.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65414.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33121.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27601.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29533.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27601.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33121.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":95408.27},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66242.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28981.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":97432.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29533.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1685.65,"10th_percentile":1685.65,"90th_percentile":1685.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45421.31,"10th_percentile":45421.31,"90th_percentile":45421.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":45708.4,"10th_percentile":45708.4,"90th_percentile":45708.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":68048.49,"10th_percentile":68048.49,"90th_percentile":68048.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26264.97,"10th_percentile":16403.21,"90th_percentile":27023.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26047.52,"10th_percentile":23905.81,"90th_percentile":28814.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19458.21,"maximum":74202.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20431.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46699.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25965.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19458.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53834.37},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35438.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62951.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74202.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46115.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23349.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19458.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19458.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23349.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":64510.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46699.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20431.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":65878.64},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20820.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16492.54,"10th_percentile":2175.19,"90th_percentile":18219.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":83075.75,"10th_percentile":83075.75,"90th_percentile":93529.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":37150.26,"10th_percentile":25822.04,"90th_percentile":64264.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17001.11,"10th_percentile":17001.11,"90th_percentile":17001.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":51967.94,"10th_percentile":50188.45,"90th_percentile":85166.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":36250.76,"10th_percentile":36250.76,"90th_percentile":36250.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16086.3,"10th_percentile":15886.66,"90th_percentile":18269.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35559.28,"10th_percentile":35559.28,"90th_percentile":35559.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20588.78,"10th_percentile":20588.78,"90th_percentile":20588.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22786.33,"10th_percentile":22786.33,"90th_percentile":22786.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18663.5,"10th_percentile":18663.5,"90th_percentile":20593.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16839.07,"10th_percentile":16839.07,"90th_percentile":17970.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15660.37,"maximum":58271.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37584.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19266.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15660.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39945.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22666.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46710.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58271.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16599.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37115.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15660.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15660.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18792.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50659.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37584.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16443.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51734.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16756.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27630.35,"10th_percentile":27630.35,"90th_percentile":27630.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44172.73,"10th_percentile":44172.73,"90th_percentile":44172.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16005.29,"10th_percentile":16005.29,"90th_percentile":16005.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":40801.27,"10th_percentile":40474.01,"90th_percentile":48452.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21207.86,"10th_percentile":21207.86,"90th_percentile":29490.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":44031.42,"10th_percentile":44031.42,"90th_percentile":44031.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12899.09,"10th_percentile":12899.09,"90th_percentile":12899.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28603.35,"10th_percentile":28603.35,"90th_percentile":28603.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3684.24,"10th_percentile":3684.24,"90th_percentile":3684.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15655.76,"10th_percentile":15655.76,"90th_percentile":15655.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27271.87,"maximum":108794.87,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28635.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29180.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29180.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65452.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38926.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27271.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80707.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61889.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94376.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108794.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28908.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64634.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32726.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27271.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29180.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27271.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32726.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":94583.42},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65452.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28635.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96589.99},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29180.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":38861.46,"10th_percentile":38861.46,"90th_percentile":38861.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17886.36,"10th_percentile":17886.36,"90th_percentile":17886.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14207.5,"maximum":65171.46,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14917.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15202.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15202.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34098.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26880.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14207.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55732.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24786.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65171.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60972.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15059.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33671.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17049.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other 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Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14917.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54132.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15202.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":28292.14,"10th_percentile":28292.14,"90th_percentile":28292.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":63914.09,"10th_percentile":63914.09,"90th_percentile":63914.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":26317.73,"10th_percentile":26317.73,"90th_percentile":26317.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15256.55,"10th_percentile":15256.55,"90th_percentile":15256.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9936.38,"maximum":45058.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed 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Plans","methodology":"fee schedule","standard_charge_dollar":38532.33},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21426.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45058.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41505.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23549.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11923.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9936.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10631.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9936.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11923.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36083.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23847.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10433.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36849.23},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10631.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22905.37,"maximum":78025.85,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54972.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26534.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22905.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55015.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45420.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64332.64},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78025.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24279.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54285.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27486.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22905.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24508.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22905.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27486.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":67833.64},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54972.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24050.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69272.72},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24508.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18799.9,"10th_percentile":18799.9,"90th_percentile":18799.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16329.05,"10th_percentile":16329.05,"90th_percentile":16329.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15719.89,"maximum":43541.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37727.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17959.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15719.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37235.49},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22332.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43541.65},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35874.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16663.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37256.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18863.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15719.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16820.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15719.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18863.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31188.37},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37727.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16505.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31850.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16820.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23966.7,"maximum":97922.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25165.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25644.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25644.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57520.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36405.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75479.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54680.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88262.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97922.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25404.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56801.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28760.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23966.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25644.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23966.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28760.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85131.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57520.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25165.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":86937.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25644.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56070.23,"10th_percentile":56070.23,"90th_percentile":56070.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16210.47,"10th_percentile":16210.47,"90th_percentile":16210.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26791.7,"10th_percentile":26791.7,"90th_percentile":26791.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":87330.79,"10th_percentile":87330.79,"90th_percentile":87330.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22881.69,"10th_percentile":22881.69,"90th_percentile":22881.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13807.35,"maximum":57134.91,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14497.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33137.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23566.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13807.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48860.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23594.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57134.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55162.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14635.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32723.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16568.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13807.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13807.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16568.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47956.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33137.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14497.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48974.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14773.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12080.29,"10th_percentile":12080.29,"90th_percentile":12080.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11396.29,"10th_percentile":11396.29,"90th_percentile":12690.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32236.87,"10th_percentile":32236.87,"90th_percentile":32236.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":49935.41,"10th_percentile":49935.41,"90th_percentile":49935.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19736.22,"10th_percentile":19736.22,"90th_percentile":19736.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13354.18,"10th_percentile":13354.18,"90th_percentile":13354.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13483.69,"10th_percentile":13483.69,"90th_percentile":13483.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11646.79,"10th_percentile":11646.79,"90th_percentile":11646.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10923.13,"maximum":43177.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26215.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15625.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32395.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16128.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37882.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43177.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11578.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25887.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10923.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10923.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13107.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37537.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26215.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38333.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11687.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21286.84,"maximum":81790.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22351.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22776.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22776.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51088.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26497.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21286.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54937.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46135.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64241.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81790.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22564.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50449.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25544.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21286.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22776.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21286.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25544.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":71106.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51088.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22351.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72614.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22776.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34173.71,"10th_percentile":34173.71,"90th_percentile":34173.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19545.63,"10th_percentile":19545.63,"90th_percentile":19545.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14675.78,"maximum":54256.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35221.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21239.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14675.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44036.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25544.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51493.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54256.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15556.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34781.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14675.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14675.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17610.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47169.46},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35221.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48170.15},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15703.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14447.54,"10th_percentile":14447.54,"90th_percentile":14447.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":34480.36,"10th_percentile":34480.36,"90th_percentile":34480.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":43563.82,"10th_percentile":43563.82,"90th_percentile":43563.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30740.11,"10th_percentile":30740.11,"90th_percentile":30740.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45179.92,"10th_percentile":45179.92,"90th_percentile":45179.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14127.9,"maximum":54256.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33906.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17501.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36286.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17244.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42431.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54256.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14975.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33483.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14127.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14127.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16953.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47169.46},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33906.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14834.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48170.15},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15116.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":26152.27,"10th_percentile":26152.27,"90th_percentile":26152.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":32267.48,"10th_percentile":32267.48,"90th_percentile":32267.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10946.79,"maximum":46326.6,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11494.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26272.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16433.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10946.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34071.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11213.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39842.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46326.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11603.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25943.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10946.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10946.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13136.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40275.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26272.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11494.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41129.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11713.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10461.33,"10th_percentile":10461.33,"90th_percentile":10461.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14225.43,"maximum":59896.98,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14936.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15221.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15221.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34141.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21599.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44781.58},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36697.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52365.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59896.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15078.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33714.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14225.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15221.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17070.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52072.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34141.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14936.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53177.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15221.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12149.27,"10th_percentile":12149.27,"90th_percentile":12149.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12131.46,"maximum":41501.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29115.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17117.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12131.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35490.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24718.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41501.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39885.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12859.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28751.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14557.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12131.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12131.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14557.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34675.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29115.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35411.48},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12980.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16270.28,"maximum":54284.63,"payers_information":[{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16270.28},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33733.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22880.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39446.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54284.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47193.64},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48194.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22931.9,"maximum":88326.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24078.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24537.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24537.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55036.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25104.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22931.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52048.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50991.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60863.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88326.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24307.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54348.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27518.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22931.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24537.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22931.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27518.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":76788.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55036.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24078.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78417.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24537.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23842.92,"10th_percentile":23842.92,"90th_percentile":23842.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20725.69,"10th_percentile":20725.69,"90th_percentile":20725.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23853.42,"10th_percentile":23853.42,"90th_percentile":23853.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22950.3,"10th_percentile":22950.3,"90th_percentile":22950.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16183.15,"maximum":60617.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16992.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17315.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17315.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38839.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18903.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16183.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39193.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34746.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45831.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60617.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17154.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38354.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19419.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16183.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17315.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16183.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19419.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52698.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38839.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16992.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53816.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17315.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":39721.11,"10th_percentile":39721.11,"90th_percentile":39721.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15329.5,"10th_percentile":15329.5,"90th_percentile":15329.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15725.87,"10th_percentile":15725.87,"90th_percentile":15725.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13142.59,"maximum":49685.97,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31542.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14507.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30077.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24903.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35171.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49685.97},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13931.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31147.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15771.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13142.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14062.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13142.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15771.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43195.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31542.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13799.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44112.07},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14062.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":17673.32,"10th_percentile":17673.32,"90th_percentile":17673.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31823.71,"10th_percentile":31823.71,"90th_percentile":31823.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":25729.63,"10th_percentile":25729.63,"90th_percentile":25729.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12718.01,"10th_percentile":12718.01,"90th_percentile":12718.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":4689.91,"10th_percentile":4689.91,"90th_percentile":4689.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12561.01,"maximum":46527.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30146.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17749.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12561.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36800.08},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20920.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43032.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46527.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13314.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29769.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12561.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12561.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40449.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30146.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13189.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41307.91},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":52669.66,"10th_percentile":52669.66,"90th_percentile":52669.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21194.93,"10th_percentile":21194.93,"90th_percentile":21194.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":17507.85,"10th_percentile":17507.85,"90th_percentile":17507.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11035.9,"10th_percentile":11035.9,"90th_percentile":11035.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10975.5,"10th_percentile":10975.5,"90th_percentile":10975.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11739.31,"10th_percentile":11739.31,"90th_percentile":11739.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8602.55,"maximum":31510.74,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20646.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12559.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26040.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12880.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30450.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31510.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9118.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20388.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8602.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8602.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10323.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27394.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20646.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9032.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27975.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24125.18,"maximum":95564.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25331.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25813.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25813.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37556.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24125.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77866.57},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53785.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91053.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95564.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25572.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57176.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28950.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24125.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25813.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24125.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28950.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":83081.23},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57900.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25331.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84843.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25813.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":89841.37,"10th_percentile":89841.37,"90th_percentile":89841.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19940.2,"10th_percentile":19940.2,"90th_percentile":19940.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18378.31,"10th_percentile":18378.31,"90th_percentile":18378.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16173.83,"maximum":67057.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16982.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17306.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17306.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38817.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27659.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57345.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29451.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67057.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62168.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17144.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38331.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19408.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16173.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17306.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16173.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19408.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54047.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38817.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16982.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55194.28},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17306.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14950.69,"10th_percentile":14950.69,"90th_percentile":14950.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34698.57,"10th_percentile":34698.57,"90th_percentile":35708.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14931.81,"10th_percentile":14931.81,"90th_percentile":14931.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":59057.16,"10th_percentile":59057.16,"90th_percentile":59057.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13690.01,"10th_percentile":6832.53,"90th_percentile":17563.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32726.3,"10th_percentile":32726.3,"90th_percentile":32726.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13206.65,"10th_percentile":1027.62,"90th_percentile":15376.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":57817.03,"10th_percentile":57817.03,"90th_percentile":57817.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12291.38,"maximum":51984.79,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29499.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21441.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44455.8},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24515.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51984.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46128.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13028.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29130.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14749.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14749.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40103.18},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29499.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40953.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13151.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11696.5,"10th_percentile":11696.5,"90th_percentile":11696.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21598.26,"10th_percentile":21598.26,"90th_percentile":29580.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":53486.84,"10th_percentile":53486.84,"90th_percentile":53486.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12053.8,"10th_percentile":9581.08,"90th_percentile":24300.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22529.71,"maximum":110757.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30037.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30037.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67373.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22529.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28072.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46711.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50695.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54622.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110757.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29756.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66531.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33686.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":28072.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30037.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28072.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33686.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":96289.54},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67373.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98332.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30037.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27205.03,"10th_percentile":27205.03,"90th_percentile":27205.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27184.26,"10th_percentile":27184.26,"90th_percentile":27184.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24738.38,"10th_percentile":24738.38,"90th_percentile":24738.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26558.91,"10th_percentile":26558.91,"90th_percentile":26558.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26774.06,"10th_percentile":26774.06,"90th_percentile":26774.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27180.34,"10th_percentile":27180.34,"90th_percentile":27180.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15615.2,"maximum":60935.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37476.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22529.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15615.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46711.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28814.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54622.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60935.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37008.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15615.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15615.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18738.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52975.64},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37476.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54099.5},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16708.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3682.42,"10th_percentile":3682.42,"90th_percentile":3682.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38837.19,"10th_percentile":38837.19,"90th_percentile":38837.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":32581.65,"10th_percentile":32581.65,"90th_percentile":32581.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15312.87,"10th_percentile":15312.87,"90th_percentile":15312.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":47703.2,"10th_percentile":47703.2,"90th_percentile":47703.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12280.09,"10th_percentile":12280.09,"90th_percentile":12280.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11984.45,"maximum":44289.96,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12583.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12823.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12823.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15208.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31531.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22576.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36871.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44289.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12703.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28403.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11984.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12823.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14381.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38504.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28762.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12583.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39321.4},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12823.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13702.12,"10th_percentile":13702.12,"90th_percentile":13702.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10359.01,"10th_percentile":10359.01,"90th_percentile":10359.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":49315.74,"10th_percentile":49315.74,"90th_percentile":49738.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":22118.61,"10th_percentile":22118.61,"90th_percentile":22118.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11234.33,"10th_percentile":11234.33,"90th_percentile":11234.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43117.72,"10th_percentile":43117.72,"90th_percentile":43117.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12816.41,"10th_percentile":12816.41,"90th_percentile":12816.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21854.08,"maximum":97669.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22946.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23383.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23383.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52449.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40285.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21854.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83523.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48496.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97669.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90075.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23165.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51794.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26224.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21854.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23383.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21854.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26224.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":78309.47},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52449.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22946.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79970.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23383.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20864.96,"10th_percentile":20864.96,"90th_percentile":20864.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":606.01,"10th_percentile":606.01,"90th_percentile":606.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15669.88,"10th_percentile":15669.88,"90th_percentile":15669.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":92979.27,"10th_percentile":92979.27,"90th_percentile":92979.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":21319.72,"10th_percentile":19754.83,"90th_percentile":22235.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22690.88,"10th_percentile":22690.88,"90th_percentile":22690.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20820.11,"10th_percentile":16051.22,"90th_percentile":22842.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16457.8,"maximum":72786.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17280.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17609.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17609.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39498.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34749.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62245.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33092.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72786.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65153.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17445.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19749.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17609.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16457.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19749.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56643.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39498.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17280.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57844.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17609.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14687.18,"10th_percentile":14687.18,"90th_percentile":15839.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16564.38,"10th_percentile":16305.21,"90th_percentile":16702.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":34975.95,"10th_percentile":34975.95,"90th_percentile":34975.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15401.0,"10th_percentile":15401.0,"90th_percentile":16116.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":68569.79,"10th_percentile":61855.59,"90th_percentile":70694.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":34266.59,"10th_percentile":34266.59,"90th_percentile":34266.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":103578.31,"10th_percentile":103578.31,"90th_percentile":103578.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":15692.68,"10th_percentile":13982.97,"90th_percentile":16427.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16160.93,"10th_percentile":16160.93,"90th_percentile":16320.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18353.92,"10th_percentile":18353.92,"90th_percentile":18353.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18297.48,"10th_percentile":18297.48,"90th_percentile":18297.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":58409.78,"10th_percentile":58409.78,"90th_percentile":58409.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15871.74,"10th_percentile":14246.35,"90th_percentile":16263.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16495.19,"10th_percentile":16495.19,"90th_percentile":16495.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12513.68,"maximum":47123.94,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13389.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13389.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30032.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17063.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12513.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35377.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28082.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41369.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47123.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13264.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29657.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12513.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13389.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12513.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15016.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40968.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30032.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41837.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13389.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11687.33,"10th_percentile":11687.33,"90th_percentile":11687.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5849.08,"maximum":27692.01,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7404.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16925.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11421.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23681.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5849.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27692.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25153.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7475.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16713.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8462.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7052.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8462.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21867.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16925.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7404.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22331.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":371.6,"10th_percentile":371.6,"90th_percentile":371.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10464.89,"maximum":41100.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10988.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11197.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11197.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25115.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16371.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33943.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13545.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39691.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41100.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24801.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12557.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10464.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11197.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10464.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12557.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35731.75},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25115.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10988.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36489.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11197.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8386.45,"10th_percentile":8386.45,"90th_percentile":8386.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":42086.31,"10th_percentile":42086.31,"90th_percentile":42086.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5942.21,"10th_percentile":5942.21,"90th_percentile":5942.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10045.62,"10th_percentile":10045.62,"90th_percentile":10045.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8526.65,"10th_percentile":8526.65,"90th_percentile":8526.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10225.18,"10th_percentile":8519.65,"90th_percentile":10712.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7062.91,"maximum":26886.16,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7557.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7557.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16950.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11089.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7062.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22992.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10337.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26886.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25060.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7486.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16739.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7062.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7557.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7062.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8475.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21787.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16950.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7416.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22249.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7557.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4587.16,"10th_percentile":4587.16,"90th_percentile":4587.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6533.36,"10th_percentile":6533.36,"90th_percentile":7237.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10161.25,"10th_percentile":10161.25,"90th_percentile":10161.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4848.79,"10th_percentile":4848.79,"90th_percentile":4848.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4229.29,"10th_percentile":4229.29,"90th_percentile":4229.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":627.11,"10th_percentile":627.11,"90th_percentile":6878.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8114.91,"maximum":28398.6,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8520.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8682.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8682.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11373.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8114.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23581.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16605.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27574.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28398.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8601.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19232.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9737.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8114.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8682.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8114.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9737.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24689.01},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8520.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25212.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8682.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":447.46,"10th_percentile":447.46,"90th_percentile":447.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12326.34,"10th_percentile":12326.34,"90th_percentile":12326.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":394.66,"10th_percentile":394.66,"90th_percentile":394.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6436.87,"maximum":21926.5,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6758.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6887.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6887.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15448.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9043.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18750.88},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12175.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21926.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20752.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6823.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15255.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7724.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6436.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6887.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6436.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7724.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18041.86},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15448.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6758.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18424.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6887.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5935.48,"10th_percentile":5935.48,"90th_percentile":5935.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15396.48,"maximum":64643.99,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16166.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36951.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26663.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55281.57},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18851.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64643.99},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62511.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16320.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36489.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15396.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18475.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54345.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36951.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16166.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55498.84},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16474.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15087.63,"10th_percentile":15087.63,"90th_percentile":15087.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14761.61,"10th_percentile":14761.61,"90th_percentile":14761.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13410.29,"10th_percentile":13410.29,"90th_percentile":13410.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29904.3,"10th_percentile":29904.3,"90th_percentile":29904.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13062.45,"10th_percentile":13062.45,"90th_percentile":13062.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13009.14,"10th_percentile":13009.14,"90th_percentile":13009.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10469.43,"maximum":51376.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25361.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21191.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43935.81},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10469.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51376.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40003.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11201.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25044.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34777.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25361.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35515.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8674.26,"10th_percentile":8674.26,"90th_percentile":8674.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24095.62,"10th_percentile":24095.62,"90th_percentile":24095.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":38076.48,"10th_percentile":38076.48,"90th_percentile":38076.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9038.48,"10th_percentile":9038.48,"90th_percentile":9038.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9197.08,"10th_percentile":9197.08,"90th_percentile":9197.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6485.48,"maximum":44325.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16603.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18282.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6918.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37905.84},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6485.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44325.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27035.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7333.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16395.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6918.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6918.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8301.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23504.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16603.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24002.76},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7402.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":29114.5,"10th_percentile":29114.5,"90th_percentile":29114.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13939.3,"maximum":57634.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14636.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33454.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22476.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13939.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46601.53},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29957.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54493.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57634.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14775.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33036.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13939.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13939.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16727.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50106.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33454.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14636.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51169.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14915.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13918.13,"10th_percentile":13918.13,"90th_percentile":13918.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45141.7,"10th_percentile":45141.7,"90th_percentile":45141.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14248.99,"10th_percentile":14248.99,"90th_percentile":14320.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":58431.51,"10th_percentile":58431.51,"90th_percentile":58431.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12158.53,"10th_percentile":12158.53,"90th_percentile":12158.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8643.42,"maximum":40845.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9075.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9248.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9248.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20744.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16847.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34930.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16134.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40845.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32784.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20484.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10372.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8643.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9248.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8643.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10372.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28501.57},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20744.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9075.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29106.23},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9248.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8210.12,"10th_percentile":8210.12,"90th_percentile":8210.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7403.04,"10th_percentile":7403.04,"90th_percentile":7403.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":432.12,"10th_percentile":432.12,"90th_percentile":432.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":16869.83,"10th_percentile":16869.83,"90th_percentile":16869.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":8400.68,"10th_percentile":8400.68,"90th_percentile":8400.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":803.54,"10th_percentile":439.58,"90th_percentile":8582.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8576.17,"10th_percentile":8576.17,"90th_percentile":8576.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":20964.23,"10th_percentile":20964.23,"90th_percentile":20964.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8222.75,"10th_percentile":688.39,"90th_percentile":9021.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6682.84,"maximum":34413.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed 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Plans","methodology":"fee schedule","standard_charge_dollar":29429.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13168.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34413.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23354.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7083.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15838.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va 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Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7002.98,"10th_percentile":7002.98,"90th_percentile":7002.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5269.05,"10th_percentile":5269.05,"90th_percentile":5269.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6309.34,"10th_percentile":6309.34,"90th_percentile":6309.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19068.1,"maximum":78087.66,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20021.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20402.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20402.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45763.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27693.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57417.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33524.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67142.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78087.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20212.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45191.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22881.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20402.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19068.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22881.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":67887.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45763.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20021.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69327.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20402.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47862.72,"10th_percentile":47862.72,"90th_percentile":47862.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44212.98,"10th_percentile":44212.98,"90th_percentile":44212.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":74410.25,"10th_percentile":74410.25,"90th_percentile":74410.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18921.34,"10th_percentile":18921.34,"90th_percentile":18921.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37678.13,"10th_percentile":37678.13,"90th_percentile":37678.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":30715.76,"10th_percentile":30715.76,"90th_percentile":30715.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1855.75,"10th_percentile":1855.75,"90th_percentile":1855.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":69374.22,"10th_percentile":69374.22,"90th_percentile":69374.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18583.85,"10th_percentile":18583.85,"90th_percentile":18583.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":76578.1,"10th_percentile":76578.1,"90th_percentile":76578.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9542.68,"maximum":44292.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22902.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18269.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9542.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37877.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16578.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44292.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35778.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10115.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22616.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9542.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9542.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11451.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31105.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22902.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10019.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31764.97},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10210.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9400.01,"10th_percentile":9400.01,"90th_percentile":9400.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16260.66,"10th_percentile":16260.66,"90th_percentile":16260.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":34333.66,"10th_percentile":34333.66,"90th_percentile":34333.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":96003.3,"10th_percentile":96003.3,"90th_percentile":96003.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7151.7,"10th_percentile":7151.7,"90th_percentile":7151.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10132.92,"10th_percentile":10132.92,"90th_percentile":10132.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9130.88,"10th_percentile":9130.88,"90th_percentile":9130.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":30893.39,"10th_percentile":30893.39,"90th_percentile":30893.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2374.54,"10th_percentile":2374.54,"90th_percentile":2374.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7268.0,"maximum":33164.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17443.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13679.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7268.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28361.25},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11548.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33164.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23061.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7704.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17225.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8721.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7268.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7268.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8721.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20048.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17443.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7631.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20474.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7776.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15118.24,"maximum":62258.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15874.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16176.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16176.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36283.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23224.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48152.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33400.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56307.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62258.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16025.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35830.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18141.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15118.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16176.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15118.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18141.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54125.59},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36283.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15874.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55273.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16176.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12867.93,"10th_percentile":12867.93,"90th_percentile":12867.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9928.49,"maximum":42204.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23828.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17407.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9928.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36092.15},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14869.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42204.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37240.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10524.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23530.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11914.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9928.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9928.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11914.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32375.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23828.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33062.79},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10623.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7539.79,"maximum":35043.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8067.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8067.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18095.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14454.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29968.2},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12251.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35043.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26643.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7992.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17869.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9047.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7539.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8067.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7539.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9047.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23162.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18095.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7916.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23654.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8067.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5997.87,"10th_percentile":5997.87,"90th_percentile":5997.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13291.03,"maximum":52733.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31898.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17574.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36436.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19199.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42607.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52733.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14088.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31499.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15949.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13291.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14221.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13291.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15949.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45844.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31898.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46817.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14221.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":608.24,"10th_percentile":608.24,"90th_percentile":608.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29138.44,"10th_percentile":29138.44,"90th_percentile":29138.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36481.28,"10th_percentile":36481.28,"90th_percentile":40123.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10923.23,"10th_percentile":661.67,"90th_percentile":13080.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14887.29,"10th_percentile":14887.29,"90th_percentile":14887.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9880.49,"10th_percentile":9880.49,"90th_percentile":9880.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11350.48,"10th_percentile":11350.48,"90th_percentile":11350.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14111.12,"10th_percentile":14111.12,"90th_percentile":14111.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8165.11,"maximum":29786.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19596.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11843.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24555.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12916.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28713.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29786.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8655.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19351.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8165.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25895.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19596.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8573.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26444.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8736.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1302.09,"10th_percentile":1302.09,"90th_percentile":1302.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":51358.12,"10th_percentile":51358.12,"90th_percentile":51358.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7184.5,"10th_percentile":422.22,"90th_percentile":8049.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18002.75,"10th_percentile":18002.75,"90th_percentile":18002.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12040.32,"10th_percentile":12040.32,"90th_percentile":12040.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7888.6,"10th_percentile":7888.6,"90th_percentile":7888.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":18416.2,"10th_percentile":15872.94,"90th_percentile":34394.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11651.78,"10th_percentile":10612.93,"90th_percentile":13115.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":23177.44,"10th_percentile":23177.44,"90th_percentile":23177.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4705.52,"10th_percentile":4705.52,"90th_percentile":4834.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28443.54,"10th_percentile":28443.54,"90th_percentile":28443.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":987.83,"10th_percentile":344.05,"90th_percentile":5551.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14133.85,"10th_percentile":14133.85,"90th_percentile":14133.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":7969.86,"10th_percentile":7756.77,"90th_percentile":8915.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7463.31,"10th_percentile":7463.31,"90th_percentile":7463.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6256.16,"10th_percentile":6256.16,"90th_percentile":6256.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5386.12,"10th_percentile":719.85,"90th_percentile":8110.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7621.49,"10th_percentile":7621.49,"90th_percentile":7621.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10567.44,"maximum":40371.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25361.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13898.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28815.45},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23045.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33695.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40371.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11201.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25044.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10567.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12680.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35097.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25361.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11095.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35842.26},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11307.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23245.69,"10th_percentile":23245.69,"90th_percentile":23245.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30017.55,"10th_percentile":30017.55,"90th_percentile":30017.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10984.29,"10th_percentile":10984.29,"90th_percentile":10984.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7224.26,"maximum":25793.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17338.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9782.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20282.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8966.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23717.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25793.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7657.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17121.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7224.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7224.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22424.03},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17338.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7585.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22899.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7729.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6152.31,"10th_percentile":6152.31,"90th_percentile":6152.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13600.68,"10th_percentile":13600.68,"90th_percentile":13600.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11939.9,"10th_percentile":11939.9,"90th_percentile":11939.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":23703.72,"10th_percentile":23703.72,"90th_percentile":23703.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":216.02,"10th_percentile":216.02,"90th_percentile":216.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10750.3,"maximum":41613.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":24702.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23997.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28886.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41613.58},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11395.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25478.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10750.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10750.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12900.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36177.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25800.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11287.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36945.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7227.84,"maximum":25233.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17346.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9001.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18663.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12422.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21823.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25233.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7661.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17129.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8673.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21937.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17346.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22403.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7733.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":22379.26,"10th_percentile":22379.26,"90th_percentile":22379.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16036.61,"10th_percentile":16036.61,"90th_percentile":16036.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6733.74,"10th_percentile":6733.74,"90th_percentile":6733.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11934.25,"maximum":47893.48,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12769.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12769.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28642.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18388.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11934.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38125.11},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18194.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44581.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47893.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28284.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14321.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11934.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12769.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11934.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14321.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41637.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28642.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42520.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12769.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10150.57,"10th_percentile":10150.57,"90th_percentile":10150.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10129.31,"10th_percentile":10129.31,"90th_percentile":10129.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28348.57,"10th_percentile":28348.57,"90th_percentile":28348.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36842.08,"10th_percentile":36842.08,"90th_percentile":36842.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16070.46,"10th_percentile":16070.46,"90th_percentile":16070.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9255.1,"10th_percentile":9255.1,"90th_percentile":10301.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":83976.36,"10th_percentile":83976.36,"90th_percentile":83976.36},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10522.77,"10th_percentile":10522.77,"90th_percentile":10522.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":21364.14,"10th_percentile":21364.14,"90th_percentile":21364.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10320.3,"10th_percentile":10320.3,"90th_percentile":10320.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7107.9,"maximum":31061.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8060.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18424.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12811.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7676.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26563.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7107.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31061.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26695.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8137.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18193.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7676.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7676.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23208.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18424.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8060.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23700.94},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6301.3,"10th_percentile":6301.3,"90th_percentile":6301.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6504.24,"10th_percentile":6504.24,"90th_percentile":6504.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16744.25,"10th_percentile":10783.01,"90th_percentile":17608.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12995.47,"10th_percentile":8254.7,"90th_percentile":13008.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":26624.89,"10th_percentile":23467.89,"90th_percentile":29794.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":6573.82,"10th_percentile":5863.37,"90th_percentile":7351.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9506.15,"10th_percentile":9506.15,"90th_percentile":9506.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5691.25,"10th_percentile":5509.99,"90th_percentile":5697.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11412.24,"10th_percentile":11412.24,"90th_percentile":11412.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5910.7,"10th_percentile":5910.7,"90th_percentile":5910.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8815.85,"10th_percentile":8815.85,"90th_percentile":8815.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1721.55,"10th_percentile":1721.55,"90th_percentile":1721.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":17631.12,"10th_percentile":17631.12,"90th_percentile":17631.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":24237.9,"10th_percentile":24237.9,"90th_percentile":24237.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14644.94,"maximum":57362.77,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15670.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15670.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35147.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18287.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14644.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37915.24},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25034.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44336.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57362.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15523.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34708.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17573.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14644.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15670.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14644.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17573.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49869.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35147.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15377.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50927.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15670.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14827.01,"10th_percentile":14827.01,"90th_percentile":14827.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":40003.24,"10th_percentile":40003.24,"90th_percentile":40003.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9985.59,"10th_percentile":9985.59,"90th_percentile":9985.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":12568.66,"10th_percentile":12568.66,"90th_percentile":12568.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9346.91,"maximum":35194.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10001.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10001.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22432.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12873.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26691.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22758.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31212.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35194.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9907.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22152.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11216.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9346.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10001.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9346.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11216.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30597.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22432.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9814.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31246.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10001.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":420.43,"10th_percentile":420.43,"90th_percentile":420.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":7900.98,"10th_percentile":7900.98,"90th_percentile":7900.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7127.16,"10th_percentile":7127.16,"90th_percentile":8591.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10526.31,"10th_percentile":10526.31,"90th_percentile":10526.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":3822.35,"10th_percentile":3822.35,"90th_percentile":3822.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7036.37,"maximum":25267.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16887.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10202.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21153.47},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15807.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24736.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25267.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7458.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16676.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7036.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7036.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8443.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21967.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16887.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7388.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22433.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":9995.25,"10th_percentile":9995.25,"90th_percentile":9995.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11488.93,"maximum":45235.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12063.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12293.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12293.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16865.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34967.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21703.18},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40889.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45235.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12178.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27228.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13786.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12293.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13786.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39326.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12063.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40161.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12293.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":17117.43,"10th_percentile":17117.43,"90th_percentile":17117.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9623.26,"10th_percentile":9623.26,"90th_percentile":9623.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":37863.36,"10th_percentile":37863.36,"90th_percentile":37863.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7693.25,"maximum":27619.8,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8077.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18463.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10547.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21867.67},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11278.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25571.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27619.8},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8154.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18233.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9231.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7693.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7693.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9231.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24011.93},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18463.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8077.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24521.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6389.12,"10th_percentile":6389.12,"90th_percentile":6389.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":22823.48,"10th_percentile":22823.48,"90th_percentile":22823.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":612.84,"10th_percentile":430.47,"90th_percentile":6968.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5396.1,"10th_percentile":5396.1,"90th_percentile":6138.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":40296.38,"10th_percentile":34006.98,"90th_percentile":52887.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10392.52,"10th_percentile":10392.52,"90th_percentile":10392.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":405.1,"10th_percentile":405.1,"90th_percentile":7408.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8157.59,"10th_percentile":8157.59,"90th_percentile":8157.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":467.13,"10th_percentile":467.13,"90th_percentile":467.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6080.3,"10th_percentile":586.14,"90th_percentile":8015.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12340.86,"maximum":48496.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12957.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13204.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29618.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17534.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12340.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee 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state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12204.11,"10th_percentile":12204.11,"90th_percentile":12301.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30585.05,"10th_percentile":30585.05,"90th_percentile":30585.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11195.24,"10th_percentile":11195.24,"90th_percentile":11764.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":18806.91,"10th_percentile":18806.91,"90th_percentile":18806.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8208.4,"10th_percentile":8208.4,"90th_percentile":8208.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12056.11,"10th_percentile":12056.11,"90th_percentile":12888.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13720.65,"10th_percentile":13720.65,"90th_percentile":13720.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11452.08,"10th_percentile":10422.91,"90th_percentile":15030.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12372.11,"10th_percentile":12372.11,"90th_percentile":12372.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8259.05,"maximum":32977.66,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8672.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8837.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8837.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19821.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13602.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8259.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28201.49},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13187.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32977.66},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31510.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8754.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19573.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9910.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8259.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8837.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8259.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9910.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27394.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19821.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8672.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27975.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8837.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7439.56,"10th_percentile":7439.56,"90th_percentile":7439.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8627.74,"10th_percentile":8627.74,"90th_percentile":8627.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20110.92,"10th_percentile":20110.92,"90th_percentile":20110.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15682.54,"10th_percentile":15682.54,"90th_percentile":15682.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7194.68,"10th_percentile":7194.68,"90th_percentile":7194.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":71133.96,"10th_percentile":71133.96,"90th_percentile":71133.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13386.87,"10th_percentile":13386.87,"90th_percentile":14099.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":32977.66,"10th_percentile":32977.66,"90th_percentile":32977.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7942.58,"10th_percentile":7942.58,"90th_percentile":7942.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":8074.11,"10th_percentile":8074.11,"90th_percentile":8074.11},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7465.44,"10th_percentile":6523.37,"90th_percentile":8798.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8208.42,"10th_percentile":8208.42,"90th_percentile":8516.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7770.45,"10th_percentile":716.21,"90th_percentile":8594.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6644.83,"maximum":28534.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15947.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11769.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6644.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24401.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12021.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28534.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23116.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7043.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15748.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7973.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6644.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6644.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7973.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20097.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15947.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6977.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20523.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7109.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":478.93,"10th_percentile":478.93,"90th_percentile":478.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":20319.19,"10th_percentile":20319.19,"90th_percentile":20319.19},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20098.2,"maximum":99903.68,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23480.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23927.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23927.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53670.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41206.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22362.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85434.58},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20098.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99903.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93036.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23704.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52999.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26835.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22362.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23927.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22362.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26835.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":80883.43},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53670.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23480.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":82599.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23927.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44864.24,"10th_percentile":44864.24,"90th_percentile":44864.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":18869.15,"10th_percentile":18869.15,"90th_percentile":18869.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20416.01,"10th_percentile":20416.01,"90th_percentile":20416.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13387.13,"maximum":73065.14,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14056.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32129.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30136.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62483.08},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18142.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73065.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51759.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14190.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31727.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16064.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13387.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13387.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16064.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44998.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32129.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14056.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45953.16},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14324.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":43290.04,"10th_percentile":43290.04,"90th_percentile":43290.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21816.53,"10th_percentile":21816.53,"90th_percentile":21816.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12958.12,"10th_percentile":12958.12,"90th_percentile":12958.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":53623.76,"10th_percentile":53623.76,"90th_percentile":53623.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7833.48,"10th_percentile":7833.48,"90th_percentile":7833.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11426.0,"10th_percentile":11426.0,"90th_percentile":13652.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9491.77,"maximum":50878.57,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9966.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10156.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10156.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22780.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20985.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43509.8},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14486.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50878.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35305.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10061.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22495.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11390.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10156.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9491.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11390.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30694.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22780.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9966.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31345.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10156.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":44486.94,"10th_percentile":44486.94,"90th_percentile":46431.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41522.53,"maximum":190306.81,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50665.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51630.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51630.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":115805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41522.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48252.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86089.26},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107437.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100669.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":190306.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51147.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":114358.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57902.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":48252.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51630.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48252.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57902.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":165447.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":115805.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50665.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":168957.72},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51630.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26165.36,"maximum":107076.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27473.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27996.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27996.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62796.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30484.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26165.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63203.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58569.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73907.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107076.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27735.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62011.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31398.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26165.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27996.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26165.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31398.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":93089.56},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62796.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27473.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95064.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27996.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14158.02,"maximum":61701.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee 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schedule","standard_charge_dollar":44530.98},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35427.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52072.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61701.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15007.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33554.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14158.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14158.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53641.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33979.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14865.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54779.97},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36418.65,"maximum":166729.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38239.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38967.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38967.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":87404.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37417.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36418.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77578.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97907.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90716.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166729.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38603.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":86312.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43702.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":36418.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38967.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36418.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43702.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":144950.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":87404.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38239.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":148025.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38967.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20280.02,"maximum":82287.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21294.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21699.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21699.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48672.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24569.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20280.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50939.98},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48094.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59567.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82287.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21496.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48063.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24336.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20280.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21699.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20280.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24336.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":71538.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48672.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21294.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73056.42},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21699.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20439.32,"10th_percentile":20439.32,"90th_percentile":20439.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19829.84,"10th_percentile":19829.84,"90th_percentile":19829.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1090.48,"10th_percentile":1090.48,"90th_percentile":1090.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12791.2,"maximum":52238.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13686.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13686.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16229.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12791.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33648.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28963.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39347.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52238.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13558.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30315.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15349.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12791.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13686.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12791.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15349.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45414.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46378.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13686.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24495.21,"maximum":100722.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25719.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26209.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26209.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58788.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34889.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24495.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72337.78},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31897.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84588.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100722.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25964.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58053.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29394.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24495.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26209.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24495.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29394.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":87565.5},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58788.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25719.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89423.19},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26209.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":35629.71,"10th_percentile":35629.71,"90th_percentile":35629.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26178.18,"10th_percentile":26178.18,"90th_percentile":26178.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22155.87,"10th_percentile":22155.87,"90th_percentile":22155.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41458.22,"10th_percentile":41458.22,"90th_percentile":41458.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":53310.12,"10th_percentile":53310.12,"90th_percentile":53310.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15942.4,"10th_percentile":15942.4,"90th_percentile":15942.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22679.31,"10th_percentile":22679.31,"90th_percentile":22679.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13663.21,"maximum":54791.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14346.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32791.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21538.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44656.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25935.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52219.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54791.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14483.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32381.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13663.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13663.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16395.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47634.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32791.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14346.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48644.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14619.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13460.94,"10th_percentile":13460.94,"90th_percentile":13460.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33905.66,"10th_percentile":33905.66,"90th_percentile":33905.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":25536.02,"10th_percentile":25536.02,"90th_percentile":25536.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13163.71,"10th_percentile":13163.71,"90th_percentile":13163.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":52044.14,"10th_percentile":52044.14,"90th_percentile":52044.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":25318.14,"10th_percentile":25318.14,"90th_percentile":26541.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26284.79,"10th_percentile":26284.79,"90th_percentile":26284.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16208.68,"10th_percentile":16208.68,"90th_percentile":16208.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23496.92,"10th_percentile":23496.92,"90th_percentile":23496.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13192.02,"10th_percentile":13192.02,"90th_percentile":13415.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11620.16,"maximum":44475.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":28580.52},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24903.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33420.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44475.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27539.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13944.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11620.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11620.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13944.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38665.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27888.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12201.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39486.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12433.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8184.53,"10th_percentile":8184.53,"90th_percentile":8184.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":38812.4,"10th_percentile":38812.4,"90th_percentile":38812.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":35729.41,"10th_percentile":35729.41,"90th_percentile":35729.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":26236.19,"10th_percentile":26236.19,"90th_percentile":26236.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11046.3,"10th_percentile":11046.3,"90th_percentile":11046.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11271.83,"10th_percentile":11271.83,"90th_percentile":11271.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14250.28,"maximum":54117.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36209.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14250.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29545.32},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43927.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34549.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54117.75},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15992.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35757.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18104.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15087.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15087.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18104.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47048.55},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36209.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48046.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16143.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11366.08,"maximum":72119.6,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14592.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14592.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32729.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11366.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23565.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72119.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27556.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50761.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14455.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32320.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16364.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13637.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14592.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13637.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16364.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44130.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32729.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45066.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14592.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16622.74,"maximum":63838.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17453.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17786.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17786.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39894.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18861.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16622.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39105.57},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63838.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45728.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63271.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17620.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39395.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19947.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16622.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17786.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16622.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19947.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":55006.86},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39894.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17453.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56173.82},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17786.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":29644.42,"10th_percentile":29644.42,"90th_percentile":29644.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13888.16,"10th_percentile":13888.16,"90th_percentile":13888.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13697.31,"maximum":61346.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16162.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16162.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36252.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13697.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28398.84},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60267.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33208.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61346.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16011.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35799.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18126.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15105.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16162.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15105.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18126.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53332.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36252.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15860.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54464.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16162.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15437.37,"10th_percentile":15437.37,"90th_percentile":15437.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31340.37,"10th_percentile":31340.37,"90th_percentile":31340.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":32412.16,"10th_percentile":32412.16,"90th_percentile":32412.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15149.79,"maximum":63546.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36359.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21990.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45592.88},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35723.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53314.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63546.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16058.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35905.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18179.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15149.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15149.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18179.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":55245.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36359.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15907.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56418.02},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16210.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15609.12,"10th_percentile":15609.12,"90th_percentile":15652.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9778.61,"maximum":40512.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10267.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10463.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10463.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23468.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16709.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34644.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12195.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40512.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37784.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10365.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23175.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11734.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9778.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10463.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9778.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11734.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32848.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23468.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10267.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33545.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10463.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":38609.3,"10th_percentile":38609.3,"90th_percentile":38609.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":35061.05,"10th_percentile":35061.05,"90th_percentile":35061.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8208.19,"10th_percentile":8208.19,"90th_percentile":9578.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":387.35,"10th_percentile":387.35,"90th_percentile":387.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7487.44,"maximum":34193.77,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7861.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17969.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14103.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29241.47},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13331.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34193.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26225.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7936.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17745.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8984.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8984.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22800.18},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17969.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7861.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23283.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8011.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16479.32,"maximum":65364.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17303.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17632.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17632.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39550.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21147.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43844.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37374.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51270.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65364.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17468.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39055.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19775.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16479.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17632.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16479.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19775.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56825.82},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39550.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17303.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58031.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17632.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15469.02,"10th_percentile":15469.02,"90th_percentile":15469.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6534.93,"maximum":33408.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9485.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21682.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13244.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9034.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27459.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6534.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32109.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33408.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9576.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21411.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10841.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9034.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9034.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10841.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29044.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21682.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9485.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29660.48},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9666.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13226.49,"maximum":54284.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13887.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14152.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14152.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31743.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21203.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13226.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43960.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29857.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51406.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54284.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14020.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31346.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13226.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14152.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13226.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15871.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47193.64},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31743.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13887.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48194.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14152.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":597.86,"10th_percentile":597.86,"90th_percentile":597.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21112.82,"10th_percentile":21112.82,"90th_percentile":21112.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":30100.47,"10th_percentile":30100.47,"90th_percentile":30100.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9384.2,"maximum":39175.4,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10041.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10041.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22522.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16158.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9384.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33501.61},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20614.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39175.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33343.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9947.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22240.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9384.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10041.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9384.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11261.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28987.89},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22522.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29602.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10041.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13699.39,"10th_percentile":13699.39,"90th_percentile":13699.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8745.69,"10th_percentile":8745.69,"90th_percentile":8745.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6788.97,"maximum":26490.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16293.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10926.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22653.91},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10837.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26490.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26420.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7196.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16089.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8146.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6788.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8146.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22969.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16293.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7128.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23456.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7264.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8537.65,"maximum":31028.97,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20978.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12798.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8740.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26535.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8537.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31028.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29582.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9265.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8740.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8740.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25718.05},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20978.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9178.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26263.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9352.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12820.78,"10th_percentile":12820.78,"90th_percentile":12820.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":11549.15,"10th_percentile":11549.15,"90th_percentile":11549.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8737.49,"10th_percentile":8737.49,"90th_percentile":8737.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":406.55,"10th_percentile":406.55,"90th_percentile":406.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5610.03,"maximum":24596.8,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5890.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6002.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6002.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10145.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5610.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21034.44},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7013.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24596.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18527.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5946.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13295.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6732.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5610.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6002.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5610.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6732.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16107.37},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13464.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5890.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16449.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6002.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11331.33,"maximum":45411.81,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27513.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11331.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11463.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23493.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16086.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27472.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45411.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12151.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27169.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13756.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11463.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11463.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13756.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39479.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27513.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40317.4},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12266.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10086.41,"10th_percentile":10086.41,"90th_percentile":10086.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10598.55,"10th_percentile":10087.18,"90th_percentile":11493.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20527.44,"10th_percentile":20527.44,"90th_percentile":31727.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10982.93,"10th_percentile":10982.93,"90th_percentile":11828.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31072.48,"10th_percentile":31072.48,"90th_percentile":31072.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16286.14,"10th_percentile":16286.14,"90th_percentile":16286.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9346.39,"10th_percentile":414.25,"90th_percentile":11645.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23160.06,"10th_percentile":23160.06,"90th_percentile":23160.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11392.94,"10th_percentile":11392.94,"90th_percentile":11919.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":305.83,"10th_percentile":305.83,"90th_percentile":305.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":9554.32,"10th_percentile":2169.42,"90th_percentile":11863.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11642.67,"10th_percentile":11642.67,"90th_percentile":11642.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7516.84,"maximum":27224.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7892.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18040.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":7554.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7516.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15662.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8202.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18314.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27224.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17814.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7516.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7516.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9020.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23668.02},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18040.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7892.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24170.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8043.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7237.85,"10th_percentile":7237.85,"90th_percentile":7352.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9580.21,"10th_percentile":9580.21,"90th_percentile":11214.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":20568.86,"10th_percentile":20568.86,"90th_percentile":40272.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7377.04,"10th_percentile":7377.04,"90th_percentile":8473.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16348.12,"10th_percentile":9487.54,"90th_percentile":17289.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"13","median_amount":7751.03,"10th_percentile":1897.84,"90th_percentile":15889.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6680.99,"10th_percentile":6100.99,"90th_percentile":7692.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"16","median_amount":16275.77,"10th_percentile":13203.87,"90th_percentile":34329.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":7135.53,"10th_percentile":6623.98,"90th_percentile":8402.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7149.24,"10th_percentile":5471.58,"90th_percentile":8431.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22043.21,"10th_percentile":22043.21,"90th_percentile":22043.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6217.64,"10th_percentile":5744.3,"90th_percentile":7371.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12730.4,"10th_percentile":12730.4,"90th_percentile":13900.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11291.43,"10th_percentile":11291.43,"90th_percentile":11291.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7191.6,"10th_percentile":7191.6,"90th_percentile":7191.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4369.2,"10th_percentile":4369.2,"90th_percentile":4369.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":9443.68,"10th_percentile":9443.68,"90th_percentile":9443.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":1251.02,"10th_percentile":341.64,"90th_percentile":7449.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":387.97,"10th_percentile":387.97,"90th_percentile":387.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11828.12,"maximum":45915.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12656.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12656.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28387.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14626.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30325.3},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22939.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35461.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45915.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12537.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28032.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14193.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11828.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12656.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11828.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14193.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39917.79},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28387.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12419.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40764.64},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12656.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12667.51,"10th_percentile":12667.51,"90th_percentile":12667.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10277.94,"10th_percentile":10277.94,"90th_percentile":10277.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":37282.38,"10th_percentile":37282.38,"90th_percentile":37282.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9497.53,"10th_percentile":9497.53,"90th_percentile":9497.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11629.59,"10th_percentile":11629.59,"90th_percentile":11629.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7840.26,"maximum":28546.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8232.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8389.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8389.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18816.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10368.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21498.04},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9721.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25138.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28546.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8310.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18581.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9408.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7840.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8389.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7840.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9408.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24817.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18816.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8232.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25344.48},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8389.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12943.78,"10th_percentile":12943.78,"90th_percentile":12943.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1114.52,"10th_percentile":1114.52,"90th_percentile":1114.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20653.72,"10th_percentile":20653.72,"90th_percentile":20653.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1007.32,"10th_percentile":1007.32,"90th_percentile":1007.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1214.14,"10th_percentile":1214.14,"90th_percentile":1214.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12122.86,"maximum":49760.14,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12729.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12971.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12971.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29094.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13934.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28890.63},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16177.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33783.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49760.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12850.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28731.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12971.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12122.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14547.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43260.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29094.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12729.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44177.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12971.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10746.49,"10th_percentile":10746.49,"90th_percentile":10746.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7771.41,"maximum":26711.19,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8159.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18651.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9828.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20376.62},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8415.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23827.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26711.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18418.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7771.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7771.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9325.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23222.01},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18651.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8159.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":23714.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8315.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10687.74,"10th_percentile":10687.74,"90th_percentile":10687.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11712.18,"10th_percentile":11712.18,"90th_percentile":11712.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":18921.23,"10th_percentile":18921.23,"90th_percentile":18921.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8614.94,"10th_percentile":8614.94,"90th_percentile":8614.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12419.12,"10th_percentile":12419.12,"90th_percentile":12419.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16989.18,"maximum":80504.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17838.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18178.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18178.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40774.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33205.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68845.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35742.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80504.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70426.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18008.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40264.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16989.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18178.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16989.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20387.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61226.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40774.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17838.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62525.71},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18178.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17049.03,"10th_percentile":17049.03,"90th_percentile":17049.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42514.77,"10th_percentile":42514.77,"90th_percentile":42514.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":29306.97,"10th_percentile":29306.97,"90th_percentile":29306.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":70232.73,"10th_percentile":70232.73,"90th_percentile":71347.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":36822.39,"10th_percentile":36822.39,"90th_percentile":37375.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74270.56,"10th_percentile":74270.56,"90th_percentile":74270.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17688.29,"10th_percentile":17688.29,"90th_percentile":17688.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17534.06,"10th_percentile":17534.06,"90th_percentile":17534.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11306.06,"maximum":60446.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11871.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27134.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24931.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11306.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51691.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25886.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60446.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44283.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11984.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26795.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11306.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11306.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13567.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38499.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27134.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11871.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39315.91},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12097.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10827.32,"10th_percentile":10827.32,"90th_percentile":10827.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26955.19,"10th_percentile":26955.19,"90th_percentile":26955.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":22395.75,"10th_percentile":22395.75,"90th_percentile":22395.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11316.35,"10th_percentile":11316.35,"90th_percentile":11316.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":27021.2,"10th_percentile":27021.2,"90th_percentile":27021.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":49209.16,"10th_percentile":49209.16,"90th_percentile":49209.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46821.2,"10th_percentile":46821.2,"90th_percentile":46821.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10985.74,"10th_percentile":10985.74,"90th_percentile":10985.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26280.1,"maximum":119444.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27594.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28119.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28119.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63072.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47514.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26280.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98512.58},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29580.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115196.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119444.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27856.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62283.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31536.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26280.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28119.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26280.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31536.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":103842.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63072.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27594.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":106045.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28119.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1684.67,"10th_percentile":1684.67,"90th_percentile":1684.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":90901.08,"10th_percentile":90901.08,"90th_percentile":90901.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14646.04,"10th_percentile":14646.04,"90th_percentile":14646.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21507.66,"10th_percentile":21507.66,"90th_percentile":21507.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":60725.98,"10th_percentile":60725.98,"90th_percentile":60725.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":29075.71,"10th_percentile":29075.71,"90th_percentile":29075.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25231.49,"10th_percentile":22798.19,"90th_percentile":28417.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14683.67,"maximum":80845.28,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15417.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15711.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15711.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35240.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33345.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69136.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19230.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80845.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59714.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34800.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17620.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14683.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15711.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14683.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17620.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51914.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35240.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15417.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53015.7},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15711.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13689.95,"10th_percentile":13689.95,"90th_percentile":14505.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12500.14,"10th_percentile":12500.14,"90th_percentile":12500.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37614.58,"10th_percentile":35670.58,"90th_percentile":37802.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":34333.04,"10th_percentile":34333.04,"90th_percentile":34333.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14204.93,"10th_percentile":14204.93,"90th_percentile":14683.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":67556.47,"10th_percentile":55487.17,"90th_percentile":80497.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17372.07,"10th_percentile":11156.76,"90th_percentile":19714.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33163.04,"10th_percentile":33163.04,"90th_percentile":33163.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14272.49,"10th_percentile":13439.16,"90th_percentile":14941.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14845.32,"10th_percentile":14845.32,"90th_percentile":14845.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":16069.66,"10th_percentile":16069.66,"90th_percentile":16069.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":78025.86,"10th_percentile":78025.86,"90th_percentile":78025.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13808.68,"10th_percentile":12914.22,"90th_percentile":15344.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":41975.77,"10th_percentile":41975.77,"90th_percentile":41975.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10817.75,"10th_percentile":10817.75,"90th_percentile":10817.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11442.32,"maximum":64299.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12014.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12243.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12243.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27461.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26521.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54987.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20229.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64299.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38476.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12128.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27118.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11442.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12243.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11442.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13730.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33450.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27461.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12014.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34160.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12243.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21977.42,"maximum":101189.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23076.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23515.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23515.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52745.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41737.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21977.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86534.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31638.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101189.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84259.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23296.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52086.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26372.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21977.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23515.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21977.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26372.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":73252.92},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52745.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23076.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74806.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23515.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19366.1,"10th_percentile":19366.1,"90th_percentile":19366.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12747.46,"maximum":70673.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13639.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13639.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30593.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29150.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60437.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24827.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70673.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49352.19},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30211.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13639.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12747.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15296.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42905.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30593.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13384.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43815.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13639.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7368.3,"10th_percentile":7368.3,"90th_percentile":7368.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13122.14,"10th_percentile":13122.14,"90th_percentile":13122.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12101.55,"10th_percentile":12101.55,"90th_percentile":12101.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"16","median_amount":61484.03,"10th_percentile":53980.32,"90th_percentile":63521.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":62062.13,"10th_percentile":62062.13,"90th_percentile":62062.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":305.5,"10th_percentile":305.5,"90th_percentile":305.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11168.95,"10th_percentile":11168.95,"90th_percentile":11538.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12480.04,"10th_percentile":12480.04,"90th_percentile":12480.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8491.95,"10th_percentile":6870.59,"90th_percentile":8597.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":44949.78,"10th_percentile":44949.78,"90th_percentile":44949.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10602.63,"10th_percentile":10598.68,"90th_percentile":12464.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":43213.41,"10th_percentile":43213.41,"90th_percentile":43213.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12787.1,"10th_percentile":12787.1,"90th_percentile":12787.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12088.43,"maximum":61816.18,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29012.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25497.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52863.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20807.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61816.18},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45173.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12813.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28649.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12088.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39272.96},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29012.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40106.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12934.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11047.85,"10th_percentile":11047.85,"90th_percentile":11047.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7550.79,"10th_percentile":7539.37,"90th_percentile":7884.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":42146.63,"10th_percentile":42146.63,"90th_percentile":42146.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13077.07,"10th_percentile":13077.07,"90th_percentile":13077.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":497.54,"10th_percentile":497.54,"90th_percentile":497.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":7468.01,"10th_percentile":7468.01,"90th_percentile":7468.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"62","median_amount":53861.66,"10th_percentile":50067.17,"90th_percentile":55299.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":7242.84,"10th_percentile":1167.45,"90th_percentile":7411.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":479.48,"10th_percentile":479.48,"90th_percentile":479.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43892.07,"10th_percentile":1933.81,"90th_percentile":46235.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7267.05,"10th_percentile":7267.05,"90th_percentile":7267.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10802.78,"10th_percentile":10802.78,"90th_percentile":10802.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7455.84,"10th_percentile":6936.47,"90th_percentile":9043.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12531.92,"10th_percentile":11407.45,"90th_percentile":12753.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"32","median_amount":7257.96,"10th_percentile":6879.93,"90th_percentile":7544.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":40860.1,"10th_percentile":39275.64,"90th_percentile":44096.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9772.03,"10th_percentile":9585.5,"90th_percentile":11270.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":41986.32,"10th_percentile":41986.32,"90th_percentile":41986.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11434.36,"10th_percentile":11434.36,"90th_percentile":11434.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26794.99,"maximum":115708.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28134.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28670.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28670.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41181.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26794.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85381.33},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65592.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99841.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115708.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28402.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63504.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32153.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26794.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28670.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26794.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32153.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":100593.79},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64307.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28134.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":102727.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28670.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":68288.33,"10th_percentile":68288.33,"90th_percentile":68288.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27784.22,"10th_percentile":27784.22,"90th_percentile":27784.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27392.29,"10th_percentile":27392.29,"90th_percentile":27392.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14135.79,"maximum":73497.37,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33925.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30315.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14135.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62852.71},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18212.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73497.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59152.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14983.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33501.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16962.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14135.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14135.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16962.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51425.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33925.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52516.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15125.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14384.39,"10th_percentile":14384.39,"90th_percentile":14384.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12611.99,"10th_percentile":12611.99,"90th_percentile":12611.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":18960.74,"10th_percentile":18960.74,"90th_percentile":18960.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":52551.2,"10th_percentile":52551.2,"90th_percentile":52551.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10249.04,"maximum":58812.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10761.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10966.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10966.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24597.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24258.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10249.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50294.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18992.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58812.55},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31000.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24290.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10249.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10966.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10249.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12298.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26951.29},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24597.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10761.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27523.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10966.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22929.03,"maximum":88601.54,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24075.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24534.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24534.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55029.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24064.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22929.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49893.74},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50407.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58343.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88601.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24304.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54341.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27514.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22929.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24534.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22929.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27514.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":77027.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55029.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24075.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":78662.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24534.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12023.89,"maximum":46641.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12625.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28857.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15384.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12023.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31897.79},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29293.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37299.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46641.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12745.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28496.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14428.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12023.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12023.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14428.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40549.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28857.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12625.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41409.43},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12865.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":754.25,"10th_percentile":754.25,"90th_percentile":754.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":28682.18,"10th_percentile":28682.18,"90th_percentile":30490.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":39397.36,"10th_percentile":39397.36,"90th_percentile":39397.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50405.55,"10th_percentile":50405.55,"90th_percentile":50405.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4891.17,"10th_percentile":4891.17,"90th_percentile":4891.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10193.0,"10th_percentile":10193.0,"90th_percentile":10193.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10796.91,"maximum":39150.45,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":25589.02},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23029.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29922.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39150.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11444.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25588.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10796.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11552.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10796.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12956.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34036.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25912.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11336.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34758.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11552.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27996.87,"maximum":121960.4,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29396.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29956.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29956.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67192.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46234.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95859.39},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43834.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112094.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121960.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29676.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66352.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33596.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29956.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27996.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33596.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":106029.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67192.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29396.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":108278.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29956.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23929.16,"10th_percentile":23929.16,"90th_percentile":23929.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":48405.69,"10th_percentile":48405.69,"90th_percentile":48405.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16895.96,"maximum":90585.1,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17740.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18078.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18078.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40550.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37363.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77465.61},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25339.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90585.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69539.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17909.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40043.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16895.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18078.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16895.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60455.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40550.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17740.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61738.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18078.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15214.39,"10th_percentile":15214.39,"90th_percentile":15214.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":1464.11,"10th_percentile":1464.11,"90th_percentile":1464.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16993.11,"10th_percentile":16993.11,"90th_percentile":16993.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11068.93,"10th_percentile":11068.93,"90th_percentile":11068.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15840.46,"10th_percentile":15840.46,"90th_percentile":15840.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11737.77,"maximum":65079.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28170.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26843.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11737.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55654.33},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24139.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65079.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43304.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12442.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27818.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11737.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11737.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14085.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37647.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28170.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12324.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38446.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45078.78,"10th_percentile":45078.78,"90th_percentile":45078.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10575.91,"maximum":45006.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12152.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12384.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12384.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27778.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11574.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21927.19},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13176.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25640.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45006.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12268.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27431.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11574.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12384.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11574.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13889.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39127.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27778.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12152.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39957.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12384.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":679.71,"10th_percentile":544.51,"90th_percentile":11245.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8282.97,"10th_percentile":8282.97,"90th_percentile":9867.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":22347.04,"10th_percentile":22347.04,"90th_percentile":22347.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7866.13,"10th_percentile":7694.51,"90th_percentile":8661.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":26552.63,"10th_percentile":19082.1,"90th_percentile":27654.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"12","median_amount":10410.46,"10th_percentile":8076.64,"90th_percentile":10827.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10960.9,"10th_percentile":10960.9,"90th_percentile":10960.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"18","median_amount":21485.41,"10th_percentile":401.58,"90th_percentile":28812.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13419.7,"10th_percentile":12801.54,"90th_percentile":13942.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":152.08,"10th_percentile":152.08,"90th_percentile":152.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7817.15,"10th_percentile":7817.15,"90th_percentile":13607.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":10200.89,"10th_percentile":7996.56,"90th_percentile":11583.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21722.55,"10th_percentile":20757.36,"90th_percentile":22900.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":20067.59,"10th_percentile":8132.37,"90th_percentile":20236.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11607.46,"10th_percentile":9558.09,"90th_percentile":12546.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":7906.47,"10th_percentile":135.59,"90th_percentile":9707.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":33249.37,"10th_percentile":33249.37,"90th_percentile":33249.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"25","median_amount":9459.96,"10th_percentile":706.3,"90th_percentile":11168.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10175.55,"10th_percentile":6419.67,"90th_percentile":12310.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7554.22,"maximum":28346.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":7554.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15662.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8622.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18314.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28346.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8160.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18244.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7698.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7698.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24643.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18475.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25166.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8237.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6139.07,"10th_percentile":5750.63,"90th_percentile":7559.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8282.97,"10th_percentile":8282.97,"90th_percentile":8282.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":51423.45,"10th_percentile":51423.45,"90th_percentile":51423.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2012.78,"10th_percentile":540.52,"90th_percentile":7952.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":17511.61,"10th_percentile":11039.6,"90th_percentile":19086.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"20","median_amount":7307.8,"10th_percentile":616.58,"90th_percentile":7751.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1223.57,"10th_percentile":1223.57,"90th_percentile":1223.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"37","median_amount":15422.19,"10th_percentile":10772.52,"90th_percentile":20843.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"26","median_amount":8551.01,"10th_percentile":7058.14,"90th_percentile":8866.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":19461.67,"10th_percentile":19461.67,"90th_percentile":19461.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":156.12,"10th_percentile":129.13,"90th_percentile":4894.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24002.8,"10th_percentile":12468.71,"90th_percentile":28999.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7509.44,"10th_percentile":7509.44,"90th_percentile":8975.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"21","median_amount":5613.64,"10th_percentile":433.64,"90th_percentile":7562.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":13668.53,"10th_percentile":13100.16,"90th_percentile":15101.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8103.22,"10th_percentile":5538.9,"90th_percentile":8271.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7545.53,"10th_percentile":7342.09,"90th_percentile":10069.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6888.67,"10th_percentile":6888.67,"90th_percentile":6888.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"15","median_amount":5356.7,"10th_percentile":163.93,"90th_percentile":8279.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":22252.79,"10th_percentile":16076.09,"90th_percentile":23870.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":6417.55,"10th_percentile":856.9,"90th_percentile":7605.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":21400.29,"10th_percentile":21400.29,"90th_percentile":21400.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6767.97,"10th_percentile":6767.97,"90th_percentile":6767.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5287.95,"maximum":19365.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13742.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":5287.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5726.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10963.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6752.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12820.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19365.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6069.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5726.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5726.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6871.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16835.49},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13742.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17192.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6127.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":21709.68,"10th_percentile":21709.68,"90th_percentile":21709.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12771.2,"10th_percentile":12771.2,"90th_percentile":12844.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":5445.4,"10th_percentile":5445.4,"90th_percentile":5539.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":11308.15,"10th_percentile":8990.74,"90th_percentile":11379.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":6721.2,"10th_percentile":6721.2,"90th_percentile":6721.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4867.93,"10th_percentile":2093.2,"90th_percentile":4952.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19631.23,"10th_percentile":14950.73,"90th_percentile":19887.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6468.5,"10th_percentile":6468.5,"90th_percentile":9740.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5520.59,"10th_percentile":5520.59,"90th_percentile":5520.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2027.3,"10th_percentile":2027.3,"90th_percentile":2027.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":14350.85,"10th_percentile":14350.85,"90th_percentile":14350.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5035.49,"10th_percentile":5035.49,"90th_percentile":5035.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":13842.09,"10th_percentile":13842.09,"90th_percentile":13842.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5223.42,"10th_percentile":5223.42,"90th_percentile":5223.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6043.38,"maximum":41044.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26038.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6043.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12529.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13918.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14651.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41044.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11500.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25712.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13019.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10849.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10849.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13019.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":35683.39},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26038.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11391.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36440.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11608.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":9029.25,"10th_percentile":8121.62,"90th_percentile":10302.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8178.46,"10th_percentile":8178.46,"90th_percentile":8178.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1026.73,"10th_percentile":402.99,"90th_percentile":10565.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24575.26,"10th_percentile":24234.32,"90th_percentile":25020.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":6295.26,"10th_percentile":5751.06,"90th_percentile":21646.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10087.95,"10th_percentile":8213.74,"90th_percentile":10431.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"15","median_amount":12529.82,"10th_percentile":10806.59,"90th_percentile":22621.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14117.87,"10th_percentile":12334.14,"90th_percentile":14543.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":156.12,"10th_percentile":129.13,"90th_percentile":7871.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39029.97,"10th_percentile":39029.97,"90th_percentile":39029.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7626.61,"10th_percentile":7626.61,"90th_percentile":16548.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"60","median_amount":8982.63,"10th_percentile":519.64,"90th_percentile":10590.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22134.07,"10th_percentile":22134.07,"90th_percentile":22134.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7934.81,"10th_percentile":7934.81,"90th_percentile":14945.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":10869.07,"10th_percentile":10356.69,"90th_percentile":11464.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11834.02,"10th_percentile":11834.02,"90th_percentile":11834.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6860.69,"10th_percentile":1036.78,"90th_percentile":16925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":22204.4,"10th_percentile":13618.37,"90th_percentile":35647.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"55","median_amount":9357.36,"10th_percentile":745.36,"90th_percentile":10485.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":35273.29,"10th_percentile":35273.29,"90th_percentile":35273.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10371.68,"10th_percentile":8954.86,"90th_percentile":10641.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5287.95,"maximum":24152.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7194.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16444.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":5287.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6852.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10963.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8471.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12820.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24152.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7263.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16239.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6852.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6852.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8222.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20997.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16444.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7194.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21442.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7331.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":6459.39,"10th_percentile":5350.16,"90th_percentile":6814.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1184.67,"10th_percentile":374.58,"90th_percentile":7769.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9653.91,"10th_percentile":229.71,"90th_percentile":16510.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":7689.17,"10th_percentile":5411.16,"90th_percentile":35325.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":6329.66,"10th_percentile":5462.4,"90th_percentile":6403.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"22","median_amount":11165.25,"10th_percentile":9236.95,"90th_percentile":14650.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8471.0,"10th_percentile":6936.67,"90th_percentile":8714.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":13579.88,"10th_percentile":13579.88,"90th_percentile":13579.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7091.8,"10th_percentile":7091.8,"90th_percentile":7091.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24838.7,"10th_percentile":24838.7,"90th_percentile":25246.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"36","median_amount":3757.8,"10th_percentile":363.61,"90th_percentile":6510.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11709.99,"10th_percentile":11709.99,"90th_percentile":12535.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7934.81,"10th_percentile":7934.81,"90th_percentile":7934.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5776.52,"10th_percentile":5776.52,"90th_percentile":5776.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6600.85,"10th_percentile":6399.43,"90th_percentile":6689.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":10110.34,"10th_percentile":10110.34,"90th_percentile":10110.34},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5814.49,"10th_percentile":4092.05,"90th_percentile":7714.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":641.54,"10th_percentile":379.97,"90th_percentile":18030.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":5372.66,"10th_percentile":630.85,"90th_percentile":7023.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":21360.01,"10th_percentile":21360.01,"90th_percentile":21360.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6369.12,"10th_percentile":337.61,"90th_percentile":6994.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6798.8,"maximum":38356.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12272.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12272.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27526.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6798.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14096.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27782.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16483.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38356.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12157.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27182.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11469.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12272.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11469.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33345.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27526.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12043.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34053.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12272.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9590.32,"10th_percentile":9590.32,"90th_percentile":9590.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":17782.64,"10th_percentile":7926.76,"90th_percentile":43021.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":163.93,"10th_percentile":163.93,"90th_percentile":163.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9582.74,"10th_percentile":9582.74,"90th_percentile":9582.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13075.9,"maximum":51218.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13991.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13991.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31382.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21040.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13075.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43622.57},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18815.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51010.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51218.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30989.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13075.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13991.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13075.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44528.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31382.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13729.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45473.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13991.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11999.76,"10th_percentile":11999.76,"90th_percentile":11999.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11022.28,"10th_percentile":8145.6,"90th_percentile":11446.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":63234.06,"10th_percentile":63234.06,"90th_percentile":63234.06},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":44038.67,"10th_percentile":41019.09,"90th_percentile":80082.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":31098.09,"10th_percentile":31098.09,"90th_percentile":31098.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41667.26,"10th_percentile":41667.26,"90th_percentile":41667.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10897.74,"10th_percentile":9379.99,"90th_percentile":12707.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12511.04,"10th_percentile":12511.04,"90th_percentile":12511.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8621.91,"maximum":38966.61,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9053.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9225.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9225.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20692.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16072.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33323.06},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12204.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38966.61},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31940.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9139.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20433.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8621.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9225.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8621.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10346.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27768.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20692.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9053.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28357.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9225.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8451.43,"10th_percentile":8451.43,"90th_percentile":8451.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19041.69,"10th_percentile":19041.69,"90th_percentile":19041.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11419.03,"10th_percentile":11419.03,"90th_percentile":11419.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":29432.89,"10th_percentile":29432.89,"90th_percentile":29432.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5453.38,"10th_percentile":5453.38,"90th_percentile":5453.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23630.5,"10th_percentile":21851.51,"90th_percentile":34570.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11049.07,"10th_percentile":11049.07,"90th_percentile":11049.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32626.75,"10th_percentile":32626.75,"90th_percentile":32626.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8438.46,"10th_percentile":8367.52,"90th_percentile":8465.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8498.6,"10th_percentile":8167.3,"90th_percentile":9422.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7336.63,"10th_percentile":7336.63,"90th_percentile":8249.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6781.08,"maximum":30439.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16274.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12555.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26030.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9306.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30439.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24075.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7187.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16071.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8137.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6781.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8137.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20930.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16274.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7120.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21374.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7255.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":26375.26,"10th_percentile":26375.26,"90th_percentile":26375.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":13980.57,"10th_percentile":13980.57,"90th_percentile":13980.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6197.0,"10th_percentile":6197.0,"90th_percentile":6197.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6448.9,"10th_percentile":6448.9,"90th_percentile":6448.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6528.74,"10th_percentile":6528.74,"90th_percentile":6528.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34985.86,"maximum":142379.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36735.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37434.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37434.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":83966.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46313.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34985.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96022.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112284.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":142379.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37085.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82916.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41983.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":34985.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37434.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34985.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41983.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":123780.88},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":83966.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36735.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":126406.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37434.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27846.28,"maximum":112284.5,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29238.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66831.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46313.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27846.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96022.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112284.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107308.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29517.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65995.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33415.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27846.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27846.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33415.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":93291.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66831.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29238.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":95270.22},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29795.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24430.67,"maximum":112284.5,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25652.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26140.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26140.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58633.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46313.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24430.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96022.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":112284.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94915.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25896.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57900.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29316.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24430.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26140.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24430.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29316.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":82517.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58633.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25652.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84267.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26140.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38535.56,"maximum":172270.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41233.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41233.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":92485.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69060.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38535.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":143184.52},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71124.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":167434.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":172270.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40847.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":91329.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46242.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":38535.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41233.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38535.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46242.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":149767.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":92485.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40462.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":152944.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41233.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28931.27,"10th_percentile":28931.27,"90th_percentile":28931.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":60821.89,"10th_percentile":60821.89,"90th_percentile":60821.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41031.15,"10th_percentile":41031.15,"90th_percentile":41031.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40190.93,"10th_percentile":40190.93,"90th_percentile":40190.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21345.65,"maximum":116702.03,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22412.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51229.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48135.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21345.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99800.02},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44525.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116702.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87210.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22626.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50589.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25614.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21345.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21345.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25614.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":75818.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51229.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22412.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":77427.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22839.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19659.56,"10th_percentile":19659.56,"90th_percentile":19659.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49161.01,"10th_percentile":49161.01,"90th_percentile":49161.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":44464.34,"10th_percentile":44464.34,"90th_percentile":49661.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":114221.5,"10th_percentile":114221.5,"90th_percentile":114221.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":46566.88,"10th_percentile":46566.88,"90th_percentile":46566.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":21067.14,"10th_percentile":21067.14,"90th_percentile":21067.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19997.06,"10th_percentile":19997.06,"90th_percentile":19997.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21369.42,"10th_percentile":21369.42,"90th_percentile":21369.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16449.92,"maximum":99174.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17272.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17601.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17601.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39479.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40906.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16449.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84811.22},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38824.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99174.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64195.87},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17436.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38986.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19739.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16449.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17601.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16449.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19739.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":55810.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39479.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17272.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":56994.21},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17601.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14602.0,"10th_percentile":14602.0,"90th_percentile":14602.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17169.38,"10th_percentile":17169.38,"90th_percentile":17169.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17924.6,"10th_percentile":17924.6,"90th_percentile":17924.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15757.1,"10th_percentile":15757.1,"90th_percentile":15757.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24102.95,"maximum":100679.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25308.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25790.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25790.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57847.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40192.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24102.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83332.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36426.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97445.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100679.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25549.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57123.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28923.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24102.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25790.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24102.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28923.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":87527.88},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57847.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25308.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":89384.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25790.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24963.88,"10th_percentile":24963.88,"90th_percentile":24963.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":86920.2,"10th_percentile":86920.2,"90th_percentile":86920.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":37676.82,"10th_percentile":37676.82,"90th_percentile":37676.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51678.19,"10th_percentile":51678.19,"90th_percentile":51678.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23994.5,"10th_percentile":23994.5,"90th_percentile":23994.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":23461.25,"10th_percentile":23461.25,"90th_percentile":23461.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23260.91,"10th_percentile":23260.91,"90th_percentile":23260.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14394.67,"maximum":69585.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34547.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28701.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59507.25},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29962.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69585.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56494.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15258.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34115.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17273.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14394.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17273.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49114.7},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34547.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15114.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50156.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15402.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13712.91,"10th_percentile":13712.91,"90th_percentile":14140.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14484.07,"10th_percentile":14484.07,"90th_percentile":15904.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":526.14,"10th_percentile":526.14,"90th_percentile":526.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":27798.48,"10th_percentile":27798.48,"90th_percentile":27844.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13061.95,"10th_percentile":13061.95,"90th_percentile":13061.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":58609.26,"10th_percentile":58461.01,"90th_percentile":62895.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59071.37,"10th_percentile":59071.37,"90th_percentile":59071.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14235.15,"10th_percentile":13295.26,"90th_percentile":14436.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14430.06,"10th_percentile":14335.83,"90th_percentile":15286.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":51918.48,"10th_percentile":51918.48,"90th_percentile":51918.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15279.27,"10th_percentile":15279.27,"90th_percentile":15319.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12399.66,"maximum":60644.03,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13019.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13267.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13267.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29759.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25013.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12399.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51860.92},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25508.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60644.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46478.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13143.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29387.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12399.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13267.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12399.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14879.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40406.79},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29759.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13019.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41264.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13267.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12014.75,"10th_percentile":12014.75,"90th_percentile":12014.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12269.22,"10th_percentile":12269.22,"90th_percentile":12269.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21369.2,"10th_percentile":21369.2,"90th_percentile":21369.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":26159.28,"10th_percentile":26159.28,"90th_percentile":26159.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11736.61,"10th_percentile":11736.61,"90th_percentile":11736.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":53518.49,"10th_percentile":49868.5,"90th_percentile":60191.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":27020.21,"10th_percentile":27020.21,"90th_percentile":27039.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50900.77,"10th_percentile":50900.77,"90th_percentile":50900.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12043.23,"10th_percentile":11903.98,"90th_percentile":15580.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22106.26,"10th_percentile":22106.26,"90th_percentile":22106.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11887.32,"10th_percentile":11887.32,"90th_percentile":11895.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13546.11,"10th_percentile":13546.11,"90th_percentile":13546.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":43126.52,"10th_percentile":43126.52,"90th_percentile":43126.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11737.43,"10th_percentile":11429.41,"90th_percentile":12095.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19492.63,"maximum":79864.7,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20857.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20857.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46782.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42483.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19492.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56756.95},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30160.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66369.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79864.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46197.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23391.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19492.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20857.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19492.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23391.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":69432.29},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46782.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20467.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70905.28},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20857.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88021.89,"10th_percentile":88021.89,"90th_percentile":88021.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18881.22,"10th_percentile":18881.22,"90th_percentile":18881.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45031.76,"10th_percentile":45031.76,"90th_percentile":45031.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":31151.82,"10th_percentile":30802.98,"90th_percentile":31476.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20430.71,"10th_percentile":20430.71,"90th_percentile":20430.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12902.17,"10th_percentile":12902.17,"90th_percentile":12902.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":991.89,"10th_percentile":991.89,"90th_percentile":991.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19203.5,"10th_percentile":17199.56,"90th_percentile":20181.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10749.58,"maximum":51296.15,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11287.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25798.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31130.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43866.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19969.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51296.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41409.61},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25476.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12899.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12899.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36000.43},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25798.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11287.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":36764.18},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8749.16,"10th_percentile":8749.16,"90th_percentile":8749.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10337.9,"10th_percentile":9562.14,"90th_percentile":11651.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24532.07,"10th_percentile":24532.07,"90th_percentile":24532.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":31910.98,"10th_percentile":31910.98,"90th_percentile":31910.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10323.88,"10th_percentile":10323.88,"90th_percentile":10323.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"15","median_amount":40350.65,"10th_percentile":33315.49,"90th_percentile":45553.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":20119.61,"10th_percentile":19613.55,"90th_percentile":20575.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9196.25,"10th_percentile":8843.16,"90th_percentile":10772.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19096.35,"10th_percentile":19096.35,"90th_percentile":19096.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19427.41,"10th_percentile":19427.41,"90th_percentile":19427.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11200.56,"10th_percentile":10629.33,"90th_percentile":11295.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":333.21,"10th_percentile":333.21,"90th_percentile":333.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":37406.11,"10th_percentile":37406.11,"90th_percentile":39252.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10391.86,"10th_percentile":8880.63,"90th_percentile":10592.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10606.5,"10th_percentile":10606.5,"90th_percentile":10606.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8696.49,"maximum":36644.29,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9131.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20871.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21157.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8696.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31337.08},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16446.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36644.29},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31727.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9218.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20610.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8696.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8696.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27582.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20871.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9131.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28167.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5736.01,"10th_percentile":5736.01,"90th_percentile":5736.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":21134.47,"10th_percentile":21134.47,"90th_percentile":27451.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8233.11,"10th_percentile":8233.11,"90th_percentile":8233.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19388.67,"10th_percentile":19388.67,"90th_percentile":19388.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":20858.04,"10th_percentile":19938.09,"90th_percentile":26345.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3706.68,"10th_percentile":3706.68,"90th_percentile":3706.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"14","median_amount":32241.22,"10th_percentile":30253.65,"90th_percentile":33670.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"14","median_amount":15598.39,"10th_percentile":14474.6,"90th_percentile":17259.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5578.99,"10th_percentile":5578.99,"90th_percentile":5578.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34142.37,"10th_percentile":34142.37,"90th_percentile":34142.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8742.58,"10th_percentile":8742.58,"90th_percentile":8742.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15640.06,"10th_percentile":15640.06,"90th_percentile":15640.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4454.81,"10th_percentile":4454.81,"90th_percentile":4454.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8382.48,"10th_percentile":8382.48,"90th_percentile":9166.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":28740.78,"10th_percentile":28598.02,"90th_percentile":28788.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8311.11,"10th_percentile":8172.26,"90th_percentile":8390.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":28594.44,"10th_percentile":28594.44,"90th_percentile":28594.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":472.94,"10th_percentile":472.94,"90th_percentile":472.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23225.92,"maximum":96405.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24387.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24851.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24851.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55742.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30783.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23225.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63823.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51309.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74632.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":96405.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24619.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55045.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27871.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23225.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24851.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23225.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27871.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":83812.04},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55742.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24387.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":85590.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24851.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21251.8,"10th_percentile":21251.8,"90th_percentile":21251.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22385.79,"10th_percentile":22385.79,"90th_percentile":22385.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":49949.02,"10th_percentile":49949.02,"90th_percentile":49949.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23205.69,"10th_percentile":23205.69,"90th_percentile":23205.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24071.59,"10th_percentile":24071.59,"90th_percentile":24071.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12173.05,"maximum":52211.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13025.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13025.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29215.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21535.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44650.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20175.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52211.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47201.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12903.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28850.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13025.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12173.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14607.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41035.5},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29215.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12781.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41906.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13025.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10781.52,"10th_percentile":10781.52,"90th_percentile":10781.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45722.34,"10th_percentile":45722.34,"90th_percentile":45722.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":20681.13,"10th_percentile":20681.13,"90th_percentile":20681.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2052.39,"10th_percentile":2052.39,"90th_percentile":2052.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11610.61,"10th_percentile":11610.61,"90th_percentile":12080.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":20785.65,"10th_percentile":20785.65,"90th_percentile":20785.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12280.52,"10th_percentile":12280.52,"90th_percentile":12280.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8778.96,"maximum":38050.87,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9217.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15694.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32539.94},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18087.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38050.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33371.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9305.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20806.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8778.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8778.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29012.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9217.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29627.55},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9393.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36860.12,"10th_percentile":36860.12,"90th_percentile":36860.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":700.64,"10th_percentile":700.64,"90th_percentile":700.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23654.03,"maximum":106109.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24836.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25309.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25309.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56769.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32321.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23654.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67012.61},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53252.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78361.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":106109.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25073.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56060.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28384.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23654.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25309.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23654.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28384.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":92248.59},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56769.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24836.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":94205.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25309.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25249.44,"10th_percentile":25249.44,"90th_percentile":25249.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13815.96,"maximum":53812.6,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33158.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22195.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46018.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29565.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53812.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50906.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14644.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32743.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16579.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13815.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16579.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44256.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33158.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14506.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45195.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12808.22,"10th_percentile":12808.22,"90th_percentile":12808.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9204.21,"maximum":34193.77,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9848.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9848.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22090.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14103.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29241.47},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18044.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34193.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31761.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9756.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21813.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9204.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9848.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9204.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11045.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27612.24},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22090.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9664.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28198.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9848.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33353.26,"10th_percentile":33353.26,"90th_percentile":33353.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3820.4,"10th_percentile":3820.4,"90th_percentile":3820.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22211.2,"maximum":90122.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23321.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23765.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23765.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53306.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25998.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53903.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48405.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63032.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90122.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23543.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52640.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26653.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22211.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23765.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22211.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26653.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":78349.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53306.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23321.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":80011.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23765.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":402.01,"10th_percentile":402.01,"90th_percentile":402.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21212.54,"10th_percentile":21212.54,"90th_percentile":21212.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19981.81,"10th_percentile":19981.81,"90th_percentile":19981.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12401.1,"maximum":47825.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13269.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13269.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29762.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18249.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12401.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37836.92},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21079.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44244.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47825.49},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13145.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29390.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14881.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12401.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13269.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12401.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14881.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41578.23},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29762.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13021.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42460.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13269.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12455.19,"10th_percentile":12455.19,"90th_percentile":12455.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10960.7,"10th_percentile":10960.7,"90th_percentile":10960.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10983.44,"10th_percentile":10983.44,"90th_percentile":10983.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12935.81,"10th_percentile":12935.81,"90th_percentile":12935.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9994.76,"10th_percentile":9994.76,"90th_percentile":11890.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10728.37,"10th_percentile":10728.37,"90th_percentile":10728.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8279.85,"maximum":32373.28,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19871.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13352.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27684.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17893.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32373.28},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29532.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19623.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8279.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9935.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25675.06},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19871.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8693.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26219.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8859.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":28877.14,"10th_percentile":28877.14,"90th_percentile":28877.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14143.68,"maximum":53267.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14850.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33944.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19350.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14143.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40120.48},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29580.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46915.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53267.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14992.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33520.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14143.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14143.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16972.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46309.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33944.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14850.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47292.14},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15133.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9012.74,"maximum":33819.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12724.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26381.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15957.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30849.48},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33819.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9553.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21360.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9012.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9012.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29401.65},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9463.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30025.4},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31401.72,"maximum":129491.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32971.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33599.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33599.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75364.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38126.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31401.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79047.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35228.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92434.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":129491.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33285.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74422.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31401.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33599.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31401.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37682.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":112576.92},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75364.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32971.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114965.22},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33599.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30512.38,"10th_percentile":30512.38,"90th_percentile":30512.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28013.11,"10th_percentile":28013.11,"90th_percentile":28013.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":85263.42,"10th_percentile":85263.42,"90th_percentile":85263.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28763.82,"10th_percentile":28763.82,"90th_percentile":28763.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":95854.14,"10th_percentile":79392.06,"90th_percentile":301171.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":144.83,"10th_percentile":144.83,"90th_percentile":144.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":55448.48,"10th_percentile":55448.48,"90th_percentile":55448.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29710.45,"10th_percentile":28835.49,"90th_percentile":31062.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64961.19,"10th_percentile":64961.19,"90th_percentile":64961.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44857.02,"10th_percentile":44857.02,"90th_percentile":44857.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":68353.07,"10th_percentile":68353.07,"90th_percentile":68353.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29960.82,"10th_percentile":27819.55,"90th_percentile":30616.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30982.01,"10th_percentile":30982.01,"90th_percentile":30982.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18041.91,"maximum":77010.16,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18944.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19304.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19304.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43300.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31763.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18041.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65856.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26398.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77010.16},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71338.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19124.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42759.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21650.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18041.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19304.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18041.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21650.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":62019.4},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43300.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18944.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":63335.14},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19304.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17392.74,"10th_percentile":17392.74,"90th_percentile":17720.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41277.85,"10th_percentile":32431.92,"90th_percentile":42641.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":31960.79,"10th_percentile":31960.79,"90th_percentile":31960.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17000.45,"10th_percentile":17000.45,"90th_percentile":17000.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":66272.83,"10th_percentile":66272.83,"90th_percentile":66272.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":54002.54,"10th_percentile":54002.54,"90th_percentile":54002.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10530.2,"10th_percentile":10530.2,"90th_percentile":10530.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74073.26,"10th_percentile":74073.26,"90th_percentile":74073.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17085.07,"10th_percentile":17085.07,"90th_percentile":18527.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17820.05,"10th_percentile":17820.05,"90th_percentile":17820.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":31482.97,"10th_percentile":31482.97,"90th_percentile":31482.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":775.71,"10th_percentile":775.71,"90th_percentile":775.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":156931.23,"10th_percentile":156931.23,"90th_percentile":156931.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17846.2,"10th_percentile":17846.2,"90th_percentile":17846.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13042.19,"maximum":62988.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13694.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31301.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25980.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13042.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53865.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17886.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62988.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48372.51},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13824.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30909.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15650.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13042.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13042.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15650.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42053.79},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31301.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13694.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42945.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13955.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":53865.7,"10th_percentile":53865.7,"90th_percentile":53865.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":788.59,"10th_percentile":788.59,"90th_percentile":788.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11891.94,"maximum":46419.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28540.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13597.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11891.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28192.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14329.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32966.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46419.31},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12605.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28183.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11891.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11891.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14270.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40355.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28540.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41211.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12724.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10869.86,"10th_percentile":9937.01,"90th_percentile":26072.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":48538.85,"10th_percentile":48538.85,"90th_percentile":48538.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":65322.37,"10th_percentile":65322.37,"90th_percentile":65322.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":9484.34,"10th_percentile":558.22,"90th_percentile":11759.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27141.15,"10th_percentile":23560.41,"90th_percentile":41220.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13005.28,"10th_percentile":9689.1,"90th_percentile":13315.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":10931.18,"10th_percentile":10191.15,"90th_percentile":11290.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"12","median_amount":28536.66,"10th_percentile":15107.52,"90th_percentile":41690.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14529.59,"10th_percentile":13504.33,"90th_percentile":38607.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47105.74,"10th_percentile":47105.74,"90th_percentile":47105.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19644.87,"10th_percentile":19644.87,"90th_percentile":19644.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"35","median_amount":10184.73,"10th_percentile":749.04,"90th_percentile":11780.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8274.81,"10th_percentile":8274.81,"90th_percentile":8274.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"18","median_amount":11745.34,"10th_percentile":11383.26,"90th_percentile":13010.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10092.83,"10th_percentile":10092.83,"90th_percentile":10092.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11053.12,"10th_percentile":11053.12,"90th_percentile":11053.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13258.84,"10th_percentile":13258.84,"90th_percentile":13310.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18088.13,"10th_percentile":18088.13,"90th_percentile":18088.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"38","median_amount":9900.9,"10th_percentile":798.71,"90th_percentile":12335.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":122223.53,"10th_percentile":122223.53,"90th_percentile":122223.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11845.79,"10th_percentile":11845.79,"90th_percentile":11845.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7551.98,"maximum":27471.45,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18124.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9820.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7551.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20360.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9239.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23809.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27471.45},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8005.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17898.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9062.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7551.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7551.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9062.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23882.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18124.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7929.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24389.64},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6027.07,"10th_percentile":5130.15,"90th_percentile":7203.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":22844.05,"10th_percentile":22844.05,"90th_percentile":22844.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":5527.86,"10th_percentile":367.92,"90th_percentile":7471.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9642.6,"10th_percentile":166.58,"90th_percentile":17211.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9684.32,"10th_percentile":5010.82,"90th_percentile":20114.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7055.71,"10th_percentile":6345.3,"90th_percentile":7960.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"19","median_amount":19910.37,"10th_percentile":14637.3,"90th_percentile":25758.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"13","median_amount":7744.57,"10th_percentile":7551.57,"90th_percentile":9439.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":21675.5,"10th_percentile":21675.5,"90th_percentile":21675.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7298.99,"10th_percentile":7298.99,"90th_percentile":7298.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27756.12,"10th_percentile":27756.12,"90th_percentile":27756.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"29","median_amount":6232.59,"10th_percentile":461.53,"90th_percentile":7387.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12436.01,"10th_percentile":12007.96,"90th_percentile":12709.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8137.66,"10th_percentile":1748.76,"90th_percentile":11158.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7233.55,"10th_percentile":5704.65,"90th_percentile":7630.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7282.14,"10th_percentile":7282.14,"90th_percentile":7282.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7939.96,"10th_percentile":7939.96,"90th_percentile":7939.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":5590.64,"10th_percentile":5590.64,"90th_percentile":5590.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"40","median_amount":6487.55,"10th_percentile":658.55,"90th_percentile":7907.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7190.69,"10th_percentile":5905.82,"90th_percentile":8886.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5576.33,"maximum":23809.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13383.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9820.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5576.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20360.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6948.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23809.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18774.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5910.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13215.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5576.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5576.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6691.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16322.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13383.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5855.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16668.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5269.23,"10th_percentile":5269.23,"90th_percentile":5269.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":357.7,"10th_percentile":357.7,"90th_percentile":357.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4937.43,"10th_percentile":4937.43,"90th_percentile":4937.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20355.93,"10th_percentile":14341.52,"90th_percentile":30516.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":6948.8,"10th_percentile":6948.8,"90th_percentile":6948.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6001.35,"10th_percentile":6001.35,"90th_percentile":6001.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8325.43,"10th_percentile":8325.43,"90th_percentile":8325.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5246.98,"10th_percentile":5246.98,"90th_percentile":5246.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":2326.91,"10th_percentile":2326.91,"90th_percentile":2326.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5293.96,"10th_percentile":3531.4,"90th_percentile":5336.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14206.07,"maximum":58274.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14916.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15200.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15200.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34094.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21926.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45461.32},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21082.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53160.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58274.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33668.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14206.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15200.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14206.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17047.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50662.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34094.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14916.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":51737.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15200.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14452.68,"10th_percentile":14452.68,"90th_percentile":14452.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34225.35,"10th_percentile":34225.35,"90th_percentile":34225.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7399.95,"10th_percentile":7399.95,"90th_percentile":7399.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21082.9,"10th_percentile":21082.9,"90th_percentile":21082.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14362.13,"10th_percentile":14362.13,"90th_percentile":14362.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8785.41,"maximum":40831.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9224.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21084.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16841.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8785.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34917.48},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15301.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40831.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32530.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9312.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20821.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8785.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8785.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10542.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28281.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21084.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9224.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28881.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9400.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8325.15,"10th_percentile":8325.15,"90th_percentile":8325.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8173.38,"10th_percentile":8173.38,"90th_percentile":8173.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":15544.97,"10th_percentile":15544.97,"90th_percentile":15544.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11069.79,"10th_percentile":11069.79,"90th_percentile":11069.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8367.55,"10th_percentile":8367.55,"90th_percentile":8367.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6938.84,"maximum":31417.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7285.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16653.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12958.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6938.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26867.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13436.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31417.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22381.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7355.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16445.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6938.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6938.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8326.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19457.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16653.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7285.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19870.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7424.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9592.16,"maximum":38779.8,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23021.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15995.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33163.3},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12720.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38779.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36171.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10167.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22733.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9592.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9592.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11510.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31446.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23021.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10071.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32113.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10263.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7219.63,"10th_percentile":426.95,"90th_percentile":8283.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8270.81,"10th_percentile":8270.81,"90th_percentile":8270.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8157.13,"10th_percentile":448.58,"90th_percentile":10342.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18230.42,"10th_percentile":18230.42,"90th_percentile":21916.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":22934.44,"10th_percentile":22934.44,"90th_percentile":22934.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6545.22,"10th_percentile":321.12,"90th_percentile":9806.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36778.35,"10th_percentile":36778.35,"90th_percentile":40574.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13029.8,"10th_percentile":13029.8,"90th_percentile":13029.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20681.56,"10th_percentile":20681.56,"90th_percentile":20681.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1686.06,"10th_percentile":1686.06,"90th_percentile":1686.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"29","median_amount":7128.57,"10th_percentile":458.95,"90th_percentile":10184.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9094.96,"10th_percentile":9094.96,"90th_percentile":9094.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8908.62,"10th_percentile":8908.62,"90th_percentile":8908.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10274.99,"10th_percentile":9990.87,"90th_percentile":16766.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9471.79,"10th_percentile":9471.79,"90th_percentile":9471.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5248.08,"10th_percentile":5248.08,"90th_percentile":5248.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":8188.01,"10th_percentile":1243.23,"90th_percentile":10008.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7532.07,"10th_percentile":7532.07,"90th_percentile":7532.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7076.53,"maximum":29303.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16983.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12086.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25059.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8299.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29303.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24804.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7501.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16771.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8491.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7076.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7076.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8491.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21564.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16983.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7430.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22021.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7571.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5262.33,"10th_percentile":1169.85,"90th_percentile":6667.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":21723.05,"10th_percentile":21723.05,"90th_percentile":21723.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5372.1,"10th_percentile":382.72,"90th_percentile":7614.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15709.71,"10th_percentile":462.27,"90th_percentile":17931.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12048.71,"10th_percentile":7638.56,"90th_percentile":17709.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":6426.34,"10th_percentile":5581.46,"90th_percentile":6561.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":21499.87,"10th_percentile":16260.14,"90th_percentile":25475.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"11","median_amount":8198.11,"10th_percentile":6839.04,"90th_percentile":8498.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25433.76,"10th_percentile":25433.76,"90th_percentile":25433.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"26","median_amount":5488.83,"10th_percentile":377.56,"90th_percentile":6950.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13500.68,"10th_percentile":11690.45,"90th_percentile":13940.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5840.01,"10th_percentile":5840.01,"90th_percentile":5840.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":7014.28,"10th_percentile":6659.13,"90th_percentile":7610.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7761.91,"10th_percentile":7761.91,"90th_percentile":7761.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5677.79,"10th_percentile":135.59,"90th_percentile":7894.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":23047.77,"10th_percentile":23047.77,"90th_percentile":23047.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":2903.1,"10th_percentile":506.69,"90th_percentile":7386.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6806.67,"10th_percentile":6806.67,"90th_percentile":6903.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10913.09,"maximum":45439.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11458.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26191.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15801.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10913.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32762.35},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14974.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38310.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45439.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25864.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13095.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10913.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11677.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10913.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13095.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39504.02},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26191.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11458.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40342.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11677.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":87701.24,"10th_percentile":87701.24,"90th_percentile":87701.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10118.19,"10th_percentile":10118.19,"90th_percentile":10118.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":73211.56,"10th_percentile":73211.56,"90th_percentile":73211.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10842.8,"10th_percentile":10842.8,"90th_percentile":10842.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11373.09,"10th_percentile":11373.09,"90th_percentile":11373.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6877.17,"maximum":26043.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10742.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22271.76},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9535.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26043.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24149.17},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16298.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6877.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6877.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8252.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":20994.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16505.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21440.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7358.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4576.44,"10th_percentile":4576.44,"90th_percentile":4576.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11167.78,"10th_percentile":11167.78,"90th_percentile":11167.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2045.83,"10th_percentile":2045.83,"90th_percentile":2045.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":22436.46,"10th_percentile":22436.46,"90th_percentile":22436.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6635.89,"10th_percentile":6635.89,"90th_percentile":6635.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":4706.97,"10th_percentile":4706.97,"90th_percentile":4706.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9473.84,"maximum":34851.57,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9947.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22737.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14235.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29513.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20560.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34512.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34851.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10042.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22453.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11368.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9473.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9473.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11368.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30299.04},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22737.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9947.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30941.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10137.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5497.55,"maximum":22988.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14909.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9482.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19659.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5497.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22988.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21376.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6585.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14723.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6212.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6212.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7454.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18584.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14909.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6523.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18978.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6647.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2515.67,"10th_percentile":2515.67,"90th_percentile":2515.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":1648.66,"10th_percentile":1648.66,"90th_percentile":1648.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5728.33,"10th_percentile":5728.33,"90th_percentile":5728.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":4994.58,"10th_percentile":4994.58,"90th_percentile":4994.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9000.54,"maximum":30960.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21601.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10912.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22625.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19138.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26457.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30960.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9540.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9000.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9000.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10800.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26916.36},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21601.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27487.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9630.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13135.42,"maximum":51948.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13792.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14054.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14054.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31525.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19666.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13135.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40775.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16317.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47680.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51948.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13923.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31130.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13135.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14054.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13135.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15762.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45162.42},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31525.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13792.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46120.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14054.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11856.13,"10th_percentile":10735.47,"90th_percentile":92361.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9400.66,"10th_percentile":9400.66,"90th_percentile":9430.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":17863.1,"10th_percentile":17863.1,"90th_percentile":17863.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11841.34,"10th_percentile":639.33,"90th_percentile":13979.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30269.33,"10th_percentile":30269.33,"90th_percentile":30269.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19863.47,"10th_percentile":19863.47,"90th_percentile":19918.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11509.92,"10th_percentile":611.17,"90th_percentile":14427.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":34903.22,"10th_percentile":16659.27,"90th_percentile":103330.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"12","median_amount":16560.85,"10th_percentile":16317.43,"90th_percentile":16947.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":46119.27,"10th_percentile":46119.27,"90th_percentile":46119.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":39902.85,"10th_percentile":39902.85,"90th_percentile":39902.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"39","median_amount":10915.36,"10th_percentile":1553.47,"90th_percentile":13041.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24018.14,"10th_percentile":24018.14,"90th_percentile":24018.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6106.1,"10th_percentile":6106.1,"90th_percentile":6106.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13947.73,"10th_percentile":13947.73,"90th_percentile":13947.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":13065.77,"10th_percentile":12710.62,"90th_percentile":13847.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14746.34,"10th_percentile":14746.34,"90th_percentile":14746.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8973.37,"10th_percentile":8973.37,"90th_percentile":8973.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":27869.8,"10th_percentile":27869.8,"90th_percentile":27869.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"40","median_amount":10677.39,"10th_percentile":807.13,"90th_percentile":12902.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":12390.91,"10th_percentile":12390.91,"90th_percentile":12390.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13112.82,"10th_percentile":13112.82,"90th_percentile":13129.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8550.2,"maximum":37919.0,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20520.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15640.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8550.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32427.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11104.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37919.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31516.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9063.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20263.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10260.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8550.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8550.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10260.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27399.99},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20520.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8977.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27981.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9148.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8094.48,"10th_percentile":6954.73,"90th_percentile":9120.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8362.25,"10th_percentile":8362.25,"90th_percentile":8362.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":23233.52,"10th_percentile":23233.52,"90th_percentile":23233.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8328.62,"10th_percentile":7424.06,"90th_percentile":10793.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8326.92,"10th_percentile":8326.92,"90th_percentile":8326.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15837.07,"10th_percentile":15837.07,"90th_percentile":23677.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8095.82,"10th_percentile":8095.82,"90th_percentile":8762.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":32761.67,"10th_percentile":19382.69,"90th_percentile":32771.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11304.59,"10th_percentile":11304.59,"90th_percentile":11304.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":218.23,"10th_percentile":218.23,"90th_percentile":218.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":6338.5,"10th_percentile":5897.49,"90th_percentile":8300.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8946.2,"10th_percentile":8946.2,"90th_percentile":8946.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8729.87,"10th_percentile":8729.87,"90th_percentile":8729.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":3822.35,"10th_percentile":3822.35,"90th_percentile":3822.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"14","median_amount":8105.52,"10th_percentile":565.65,"90th_percentile":8890.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":24954.3,"10th_percentile":24954.3,"90th_percentile":24954.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6814.18,"10th_percentile":6814.18,"90th_percentile":6814.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6218.86,"maximum":30153.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6529.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14925.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12437.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6218.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25786.37},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7300.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30153.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21451.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6591.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14738.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6218.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6218.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7462.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18649.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14925.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6529.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19044.72},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6654.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5926.09,"10th_percentile":5926.09,"90th_percentile":5926.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6063.1,"10th_percentile":6063.1,"90th_percentile":6063.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15615.91,"maximum":59971.15,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16396.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16709.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16709.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37478.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23449.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15615.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48618.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30743.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56852.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59971.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16552.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37009.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15615.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16709.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15615.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18739.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52137.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37478.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16396.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53243.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16709.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12942.27,"10th_percentile":12942.27,"90th_percentile":12942.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":18942.31,"10th_percentile":18942.31,"90th_percentile":18942.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15392.57,"10th_percentile":15392.57,"90th_percentile":15392.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":50442.54,"10th_percentile":50442.54,"90th_percentile":50442.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15426.99,"10th_percentile":15426.99,"90th_percentile":15426.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28967.15,"10th_percentile":28967.15,"90th_percentile":28967.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15348.7,"10th_percentile":15348.7,"90th_percentile":15348.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12273.45,"maximum":45813.57,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13132.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13132.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29456.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17915.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12273.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37144.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24950.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43435.43},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45813.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13009.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29088.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14728.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12273.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13132.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12273.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14728.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39829.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29456.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12887.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40674.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13132.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":42118.98,"10th_percentile":42118.98,"90th_percentile":42118.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17959.44,"maximum":69443.54,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18857.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19216.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19216.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43102.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24375.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50539.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36385.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59098.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69443.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19037.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42563.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21551.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17959.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19216.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21551.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60372.4},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43102.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18857.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61653.19},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19216.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":330.82,"10th_percentile":330.82,"90th_percentile":330.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":20386.51,"10th_percentile":20386.51,"90th_percentile":20386.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18868.66,"10th_percentile":18868.66,"90th_percentile":18868.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11319.69,"maximum":47567.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11885.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27167.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19619.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40678.06},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21587.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47567.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46397.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11998.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26827.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13583.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11319.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11319.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13583.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40336.93},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27167.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11885.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41192.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12112.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16214.7,"maximum":59047.09,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17025.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17349.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17349.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38915.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24250.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16214.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50279.04},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36529.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58794.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59047.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17187.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38428.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19457.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16214.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17349.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16214.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19457.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":51334.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38915.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17025.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52423.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17349.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27247.12,"10th_percentile":27247.12,"90th_percentile":27247.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14120.47,"10th_percentile":14120.47,"90th_percentile":14120.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17096.26,"10th_percentile":17096.26,"90th_percentile":17096.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9157.59,"maximum":39713.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9615.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21978.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16380.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9157.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33962.08},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20259.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39713.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33055.99},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9707.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21703.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10989.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9157.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9157.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10989.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28738.01},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21978.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9615.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29347.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9798.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12052.58,"maximum":44685.54,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12655.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28926.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14881.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12052.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30854.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15910.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36080.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44685.54},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12775.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28564.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14463.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12052.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12052.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14463.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38848.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28926.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12655.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39672.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12896.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28246.5,"10th_percentile":28246.5,"90th_percentile":28246.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9566.84,"10th_percentile":9566.84,"90th_percentile":9566.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11864.71,"10th_percentile":11864.71,"90th_percentile":11864.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8854.25,"maximum":29038.34,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21250.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10137.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21018.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16537.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24578.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29038.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9385.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20984.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10625.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8854.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10625.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25245.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21250.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9296.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25780.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9474.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17315.47,"maximum":69789.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18527.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18527.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23115.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17315.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47926.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38099.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56043.35},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69789.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18354.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41037.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17315.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18527.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17315.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20778.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":60673.32},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41557.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18181.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61960.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18527.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":49578.62,"10th_percentile":49578.62,"90th_percentile":49578.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15298.89,"10th_percentile":15298.89,"90th_percentile":15298.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11820.23,"maximum":43860.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12647.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12647.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28368.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17087.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11820.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35428.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24528.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41428.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43860.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12529.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28013.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14184.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11820.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12647.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11820.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14184.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38131.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28368.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12411.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38940.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12647.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14828.52,"maximum":57341.14,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35588.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23649.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14828.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49032.32},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21505.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57336.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57341.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15718.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35143.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17794.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14828.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14828.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17794.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49850.89},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35588.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50908.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15866.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13820.24,"10th_percentile":13820.24,"90th_percentile":13820.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":18765.53,"10th_percentile":18765.53,"90th_percentile":18765.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10903.05,"maximum":38068.78,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11448.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26167.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15605.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32355.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13992.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37834.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38068.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11557.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25840.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13083.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10903.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13083.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33096.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26167.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11448.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33798.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11666.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":33545.25,"10th_percentile":33545.25,"90th_percentile":33545.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14249.1,"maximum":53428.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14961.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15246.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15246.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34197.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19379.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14249.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40180.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32269.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46984.84},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53428.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15104.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33770.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17098.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14249.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15246.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14249.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17098.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46449.4},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34197.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14961.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47434.81},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15246.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10522.56,"10th_percentile":10522.56,"90th_percentile":10522.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":31594.51,"10th_percentile":31594.51,"90th_percentile":31594.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":46817.44,"10th_percentile":46817.44,"90th_percentile":46817.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9465.95,"maximum":38838.41,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10128.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10128.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22718.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16019.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33213.42},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19045.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38838.41},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34703.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10033.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22434.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9465.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10128.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9465.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11359.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30170.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22718.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9939.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30810.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10128.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5973.61,"maximum":28120.57,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14336.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11598.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24047.86},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14256.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28120.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22517.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6332.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14157.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5973.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7168.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19576.02},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14336.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19991.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9663.16,"maximum":39036.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10339.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10339.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23191.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13704.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28414.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21426.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33226.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39036.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10242.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22901.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11595.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9663.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10339.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9663.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11595.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33936.97},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23191.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10146.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34656.94},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10339.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6449.06,"maximum":25223.17,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6771.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6900.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6900.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15477.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10403.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6449.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21570.09},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12117.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25223.17},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23002.59},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6836.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15284.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6449.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6900.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6449.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19997.85},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15477.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6771.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":20422.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6900.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5628.14,"10th_percentile":5628.14,"90th_percentile":5628.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6178.65,"10th_percentile":6178.65,"90th_percentile":6178.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4672.92,"10th_percentile":4672.92,"90th_percentile":4672.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11905.57,"maximum":45408.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28573.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15233.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11905.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31584.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27802.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36933.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45408.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12619.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28216.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11905.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11905.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14286.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39477.15},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28573.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40314.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12738.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9230.05,"10th_percentile":9230.05,"90th_percentile":9230.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9623.26,"10th_percentile":9623.26,"90th_percentile":9623.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13644.67,"10th_percentile":13644.67,"90th_percentile":13644.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7088.72,"maximum":26523.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17012.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10940.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22682.11},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8299.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26523.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25252.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7514.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16800.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8506.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7088.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7088.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8506.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21953.84},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17012.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7443.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22419.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7584.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11757.8,"10th_percentile":11757.8,"90th_percentile":16035.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6447.63,"10th_percentile":6447.63,"90th_percentile":6447.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":10812.34,"10th_percentile":10812.34,"90th_percentile":10812.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":9375.33,"10th_percentile":9375.33,"90th_percentile":9375.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5733.06,"10th_percentile":5733.06,"90th_percentile":5733.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11531.77,"10th_percentile":11531.77,"90th_percentile":11531.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6707.81,"10th_percentile":6707.81,"90th_percentile":6707.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8863.58,"maximum":34952.0,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9484.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9484.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21272.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14416.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8863.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29889.89},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17220.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34952.0},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34020.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21006.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8863.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9484.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8863.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10636.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29576.29},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21272.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9306.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30203.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9484.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":40767.22,"10th_percentile":40767.22,"90th_percentile":40767.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8865.34,"10th_percentile":8865.34,"90th_percentile":8865.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6090.5,"maximum":25853.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6395.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6516.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6516.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14617.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10663.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22108.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10439.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25853.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18756.24},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6455.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14434.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6090.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6516.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6090.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7308.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16306.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14617.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6395.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16652.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6516.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16546.01,"maximum":73936.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":63228.6},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37404.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73936.93},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64983.94},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17538.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39214.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19855.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17373.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57693.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17704.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10920.26,"maximum":50541.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33304.24},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26904.71,"maximum":121682.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":100576.87},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66748.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":117610.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121682.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28518.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63764.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32285.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26904.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28788.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26904.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32285.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":105787.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64571.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28249.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":108031.64},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28788.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16048.33,"maximum":77002.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":65850.47},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24215.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77002.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61757.46},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17011.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38034.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19258.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16048.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16048.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19258.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53690.32},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38515.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16850.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54829.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17171.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":31960.96,"10th_percentile":31960.96,"90th_percentile":31960.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":67571.44,"10th_percentile":67571.44,"90th_percentile":68102.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":25585.75,"10th_percentile":25585.75,"90th_percentile":25585.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59021.41,"10th_percentile":59021.41,"90th_percentile":59021.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13430.17,"10th_percentile":13430.17,"90th_percentile":13430.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32209.07,"10th_percentile":32209.07,"90th_percentile":32209.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":60486.15,"10th_percentile":60486.15,"90th_percentile":60486.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11802.31,"maximum":61369.3,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12392.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12628.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12628.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28325.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25312.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52481.15},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16680.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61369.3},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46876.7},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12510.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27971.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14162.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11802.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12628.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11802.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14162.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40753.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28325.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12392.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41617.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12628.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":52807.61,"10th_percentile":52807.61,"90th_percentile":52807.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16267.97,"10th_percentile":16267.97,"90th_percentile":16267.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10901.04,"10th_percentile":10901.04,"90th_percentile":10901.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26964.23,"maximum":123023.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28851.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28851.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64714.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33360.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26964.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69167.74},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62455.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80881.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123023.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28582.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":63905.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32357.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":26964.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28851.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26964.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32357.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":106953.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64714.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28312.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":109222.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28851.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":286850.72,"10th_percentile":286850.72,"90th_percentile":286850.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29123.34,"10th_percentile":29123.34,"90th_percentile":29123.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14248.38,"maximum":56191.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14960.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15245.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15245.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34196.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22023.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14248.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45661.8},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23243.65},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53395.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56191.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15103.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33768.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17098.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14248.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15245.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14248.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17098.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48851.4},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34196.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14960.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49887.77},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15245.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13841.72,"10th_percentile":13841.72,"90th_percentile":13841.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45153.29,"10th_percentile":45153.29,"90th_percentile":45153.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":24497.06,"10th_percentile":23367.13,"90th_percentile":26700.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":48138.27,"10th_percentile":48138.27,"90th_percentile":48138.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12230.14,"10th_percentile":12230.14,"90th_percentile":12230.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14164.18,"10th_percentile":14164.18,"90th_percentile":14164.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11498.25,"maximum":42448.02,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27595.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15573.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32289.35},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15988.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37757.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42448.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12188.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27250.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11498.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11498.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13797.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36903.2},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27595.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12073.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37686.09},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12303.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":5650.37,"10th_percentile":5650.37,"90th_percentile":5650.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9843.6,"10th_percentile":9843.6,"90th_percentile":9843.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8825.35,"10th_percentile":8825.35,"90th_percentile":8825.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22361.69,"10th_percentile":22361.69,"90th_percentile":22361.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10619.71,"10th_percentile":10619.71,"90th_percentile":10619.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14429.09,"maximum":56451.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15150.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15439.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15439.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34629.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18767.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14429.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38911.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21777.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45501.34},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56451.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15294.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34196.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14429.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15439.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14429.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49077.09},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34629.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15150.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50118.25},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15439.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10466.17,"10th_percentile":10466.17,"90th_percentile":10466.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":461.03,"10th_percentile":461.03,"90th_percentile":461.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1430.38,"10th_percentile":1430.38,"90th_percentile":1430.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32809.17,"10th_percentile":32809.17,"90th_percentile":61528.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19410.47,"10th_percentile":17888.0,"90th_percentile":27074.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13265.83,"10th_percentile":13265.83,"90th_percentile":13265.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"26","median_amount":38547.79,"10th_percentile":35326.33,"90th_percentile":41170.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"13","median_amount":20621.72,"10th_percentile":18263.9,"90th_percentile":22847.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":46780.01,"10th_percentile":46780.01,"90th_percentile":46780.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":444.53,"10th_percentile":444.53,"90th_percentile":444.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57347.44,"10th_percentile":54990.36,"90th_percentile":61510.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28695.63,"10th_percentile":28695.63,"90th_percentile":28695.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10275.96,"10th_percentile":8778.12,"90th_percentile":13480.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":51319.36,"10th_percentile":44989.32,"90th_percentile":65525.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10168.72,"maximum":37042.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24404.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13102.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10168.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27164.65},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16353.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31765.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37042.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24099.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12202.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10168.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10168.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12202.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32203.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24404.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32887.19},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10880.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10765.28,"10th_percentile":10765.28,"90th_percentile":10765.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":45685.99,"10th_percentile":41294.9,"90th_percentile":47727.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22655.52,"10th_percentile":22655.52,"90th_percentile":22655.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12833.36,"10th_percentile":9033.4,"90th_percentile":16231.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"40","median_amount":28156.91,"10th_percentile":24906.29,"90th_percentile":29410.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"22","median_amount":15457.63,"10th_percentile":14604.39,"90th_percentile":16257.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":32857.94,"10th_percentile":30995.41,"90th_percentile":33750.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":528.43,"10th_percentile":528.43,"90th_percentile":528.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38205.49,"10th_percentile":1737.92,"90th_percentile":39979.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17593.05,"10th_percentile":17176.68,"90th_percentile":19091.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10368.48,"10th_percentile":10368.48,"90th_percentile":10368.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8625.81,"10th_percentile":8625.81,"90th_percentile":10280.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":33789.75,"10th_percentile":1939.35,"90th_percentile":35713.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":33802.87,"10th_percentile":33802.87,"90th_percentile":33802.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":778.85,"10th_percentile":778.85,"90th_percentile":778.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15965.86,"maximum":60385.28,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16764.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38318.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17973.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15965.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37263.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20913.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43574.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60385.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16923.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37839.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19159.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15965.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17083.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15965.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19159.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52497.39},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38318.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16764.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53611.11},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17083.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31869.53,"10th_percentile":31869.53,"90th_percentile":31869.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":54953.82,"10th_percentile":54953.82,"90th_percentile":54953.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9428.66,"maximum":31721.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9900.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22628.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13083.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9428.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27127.06},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17861.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31721.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31671.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9994.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22345.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11314.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9428.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9428.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11314.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27534.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22628.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9900.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28118.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13728.47,"maximum":51750.42,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee 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state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13839.09,"10th_percentile":13839.09,"90th_percentile":13839.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18012.59,"10th_percentile":18012.59,"90th_percentile":18012.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7436.52,"maximum":31131.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7957.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7957.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17847.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12840.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7436.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26622.74},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18698.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31131.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29517.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7882.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17624.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8923.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7436.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7957.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7436.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8923.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25661.63},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17847.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26206.03},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7957.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17732.96,"10th_percentile":17732.96,"90th_percentile":17732.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11220.01,"maximum":42098.79,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11781.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11959.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11220.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24796.51},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24530.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28996.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42098.79},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11893.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26591.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13464.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11220.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11220.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13464.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":36599.59},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26928.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11781.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":37376.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12005.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10464.25,"10th_percentile":10464.25,"90th_percentile":10464.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19684.1,"maximum":83563.2,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20668.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21061.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21061.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47241.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34466.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19684.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71460.7},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25779.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83563.2},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79994.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20865.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46651.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23620.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19684.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21061.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19684.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23620.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":69545.13},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47241.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20668.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":71020.52},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21061.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":67466.25,"10th_percentile":67466.25,"90th_percentile":67466.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11854.66,"maximum":54918.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12684.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12684.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22652.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46964.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23611.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54918.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39852.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12565.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28095.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11854.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12684.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11854.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14225.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34646.29},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28451.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12447.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35381.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12684.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23413.99,"10th_percentile":23413.99,"90th_percentile":23413.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":32343.97,"10th_percentile":32343.97,"90th_percentile":32343.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":24833.15,"10th_percentile":24833.15,"90th_percentile":24833.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":29702.42,"10th_percentile":29702.42,"90th_percentile":29702.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14478.57,"maximum":57127.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15202.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15492.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15492.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34748.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23563.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14478.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48853.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23797.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57127.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55913.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15347.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34314.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14478.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15492.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14478.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17374.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48609.59},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34748.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15202.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49640.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15492.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12717.71,"10th_percentile":12717.71,"90th_percentile":12717.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":229.71,"10th_percentile":229.71,"90th_percentile":229.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10005.36,"10th_percentile":10005.36,"90th_percentile":10005.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9072.26,"maximum":42519.69,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9525.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9707.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9707.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21773.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17537.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36361.54},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11517.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42519.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34307.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9616.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21501.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10886.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9072.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9707.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9072.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10886.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29826.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21773.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9525.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30458.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9707.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8350.74,"10th_percentile":8350.74,"90th_percentile":8350.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":35024.99,"10th_percentile":33360.28,"90th_percentile":40392.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9413.88,"10th_percentile":9413.88,"90th_percentile":9413.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8159.37,"maximum":29511.18,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8567.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19582.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11636.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8159.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24126.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17213.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28212.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29511.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8648.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19337.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8159.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8159.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9791.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25656.25},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19582.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8567.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26200.55},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8730.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11539.84,"maximum":43736.76,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27695.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21647.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31424.79},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25518.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36746.85},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43736.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12232.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27349.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13847.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11539.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12347.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11539.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13847.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38023.59},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27695.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12116.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38830.26},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12347.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17387.0,"10th_percentile":17387.0,"90th_percentile":17387.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8663.6,"10th_percentile":8663.6,"90th_percentile":8663.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8292.04,"maximum":31501.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8706.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19900.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16841.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8292.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26779.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9262.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31314.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31501.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8789.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19652.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8292.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8292.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9950.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27386.55},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19900.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8706.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27967.55},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8872.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":12413.36,"10th_percentile":12413.36,"90th_percentile":12413.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":21635.59,"10th_percentile":21635.59,"90th_percentile":21635.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":24607.2,"10th_percentile":24607.2,"90th_percentile":24607.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8144.04,"10th_percentile":8144.04,"90th_percentile":8144.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6030.26,"maximum":19776.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14472.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14517.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14293.39},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6606.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16714.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19776.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6392.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14291.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6030.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6030.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7236.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17192.83},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14472.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6331.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17557.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6452.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":16228.24,"10th_percentile":16228.24,"90th_percentile":16228.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6555.49,"10th_percentile":6555.49,"90th_percentile":6555.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":14714.51,"10th_percentile":14714.51,"90th_percentile":14714.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":13755.59,"10th_percentile":12658.07,"90th_percentile":14709.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10111.91,"10th_percentile":10111.91,"90th_percentile":10111.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4611.11,"10th_percentile":4611.11,"90th_percentile":4611.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8496.41,"maximum":30456.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10439.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21645.26},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9458.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25311.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30456.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9006.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20136.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10195.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8496.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10195.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26478.41},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20391.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8921.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27040.15},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9091.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9882.83,"10th_percentile":9882.83,"90th_percentile":9882.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":19397.58,"10th_percentile":19397.58,"90th_percentile":21145.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13795.62,"10th_percentile":13795.62,"90th_percentile":13795.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31638.36,"10th_percentile":31638.36,"90th_percentile":31638.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":241.61,"10th_percentile":241.61,"90th_percentile":241.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8082.3,"10th_percentile":8082.3,"90th_percentile":8082.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":23886.22,"10th_percentile":23886.22,"90th_percentile":23886.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5362.63,"maximum":20399.05,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5630.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12870.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8413.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17444.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6778.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20399.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19590.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5684.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12709.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6435.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5362.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5362.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6435.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17031.63},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12870.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5630.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17392.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5738.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5265.25,"10th_percentile":5265.25,"90th_percentile":5265.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":17160.74,"10th_percentile":17160.74,"90th_percentile":17160.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":6778.95,"10th_percentile":6778.95,"90th_percentile":6778.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. 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Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21476.36,"10th_percentile":21476.36,"90th_percentile":21476.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"15","median_amount":18815.31,"10th_percentile":11033.96,"90th_percentile":25583.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"47","median_amount":12478.27,"10th_percentile":10618.76,"90th_percentile":12974.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"24","median_amount":7334.91,"10th_percentile":6272.06,"90th_percentile":8034.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":14468.56,"10th_percentile":14468.56,"90th_percentile":14468.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3905.28,"10th_percentile":3905.28,"90th_percentile":3905.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9597.5,"10th_percentile":8153.36,"90th_percentile":10769.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16550.5,"10th_percentile":16550.5,"90th_percentile":16550.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5315.01,"10th_percentile":4707.74,"90th_percentile":5912.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9913.2,"10th_percentile":9913.2,"90th_percentile":9913.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"19","median_amount":5167.37,"10th_percentile":4229.72,"90th_percentile":15424.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":17360.0,"10th_percentile":10321.89,"90th_percentile":20651.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":15229.87,"10th_percentile":15229.87,"90th_percentile":15229.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13389.28,"maximum":42942.5,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14058.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32134.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28878.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13389.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17808.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16904.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20823.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42942.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14192.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31732.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13389.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14326.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13389.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16067.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37333.09},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32134.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14058.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38125.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14326.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":28409.11,"10th_percentile":28409.11,"90th_percentile":28409.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":18865.79,"10th_percentile":18698.46,"90th_percentile":19404.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16193.64,"10th_percentile":16193.64,"90th_percentile":16193.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":13452.93,"10th_percentile":13452.93,"90th_percentile":13452.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5841.03,"10th_percentile":5841.03,"90th_percentile":5841.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15867.18,"10th_percentile":15867.18,"90th_percentile":15867.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":379.97,"10th_percentile":379.97,"90th_percentile":379.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8461.99,"maximum":33250.69,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9054.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9054.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11083.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22979.69},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10100.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26871.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33250.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8969.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20054.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8461.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9054.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8461.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10154.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28907.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20308.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8885.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29520.54},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9054.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20697.18,"10th_percentile":20697.18,"90th_percentile":25817.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9078.34,"10th_percentile":9078.34,"90th_percentile":9078.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32838.38,"10th_percentile":32838.38,"90th_percentile":32838.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14837.7,"10th_percentile":14837.7,"90th_percentile":14837.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":14399.03,"10th_percentile":14399.03,"90th_percentile":14399.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4203.1,"10th_percentile":4157.19,"90th_percentile":7544.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":7853.43,"10th_percentile":7853.43,"90th_percentile":7853.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6435.98,"10th_percentile":6435.98,"90th_percentile":6435.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9572.77,"10th_percentile":8257.21,"90th_percentile":9760.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"29","median_amount":12284.94,"10th_percentile":7819.28,"90th_percentile":15827.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"17","median_amount":4633.25,"10th_percentile":3489.34,"90th_percentile":4833.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":14595.97,"10th_percentile":14595.97,"90th_percentile":17649.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2576.36,"10th_percentile":1526.19,"90th_percentile":3690.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16969.77,"10th_percentile":12059.98,"90th_percentile":20174.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1584.43,"10th_percentile":1584.43,"90th_percentile":1584.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2682.27,"10th_percentile":2542.81,"90th_percentile":15820.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6087.5,"10th_percentile":6087.5,"90th_percentile":6087.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":1655.46,"10th_percentile":163.93,"90th_percentile":2829.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":6175.0,"10th_percentile":2754.47,"90th_percentile":13142.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":15877.38,"10th_percentile":15877.38,"90th_percentile":15877.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6625.23,"maximum":28886.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7669.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17530.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9084.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7304.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18835.45},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6625.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22025.4},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28886.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7742.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17311.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8765.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7304.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7304.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8765.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25113.52},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17530.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7669.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25646.3},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7815.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11051.83,"10th_percentile":11051.83,"90th_percentile":11051.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5980.07,"10th_percentile":5980.07,"90th_percentile":5980.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3257.16,"10th_percentile":3257.16,"90th_percentile":3257.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":14406.12,"10th_percentile":14406.12,"90th_percentile":14406.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10575.91,"maximum":56927.01,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19821.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20198.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20198.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18877.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22090.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13461.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25831.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56927.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20009.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44739.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22652.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18877.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20198.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18877.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22652.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49490.86},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45305.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19821.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50540.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20198.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10002.01,"10th_percentile":10002.01,"90th_percentile":10002.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":9231.95,"10th_percentile":9231.95,"90th_percentile":9231.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10568.01,"10th_percentile":10568.01,"90th_percentile":10568.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":22597.84,"10th_percentile":19743.23,"90th_percentile":23381.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13881.41,"10th_percentile":13311.62,"90th_percentile":14274.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":25357.98,"10th_percentile":25357.98,"90th_percentile":25357.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15462.8,"10th_percentile":15462.8,"90th_percentile":15462.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13853.83,"10th_percentile":13853.83,"90th_percentile":13853.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17333.31,"10th_percentile":17333.31,"90th_percentile":17333.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8873.62,"maximum":33470.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21296.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22090.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13461.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25831.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33470.12},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9406.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21030.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8873.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8873.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10648.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29098.04},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21296.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9317.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29715.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":350.23,"10th_percentile":350.23,"90th_percentile":350.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":15578.96,"10th_percentile":15578.96,"90th_percentile":15578.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21963.8,"10th_percentile":21963.8,"90th_percentile":21963.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12773.62,"10th_percentile":12773.62,"90th_percentile":12773.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"35","median_amount":22352.57,"10th_percentile":20026.49,"90th_percentile":23475.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"17","median_amount":12479.05,"10th_percentile":11690.8,"90th_percentile":14344.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":25825.85,"10th_percentile":25825.85,"90th_percentile":27960.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6430.85,"10th_percentile":6430.85,"90th_percentile":6497.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12633.29,"10th_percentile":12633.29,"90th_percentile":15066.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6782.4,"10th_percentile":6782.4,"90th_percentile":6782.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7327.15,"10th_percentile":7294.49,"90th_percentile":9798.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8870.95,"10th_percentile":8870.95,"90th_percentile":8882.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6238.2,"10th_percentile":5903.13,"90th_percentile":9526.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":17409.24,"10th_percentile":17409.24,"90th_percentile":29984.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":13559.91,"10th_percentile":13559.91,"90th_percentile":13559.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8140.01,"maximum":27893.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8709.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8709.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23853.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11429.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27893.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27038.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8628.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19291.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9768.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8140.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8709.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8140.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9768.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23506.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19536.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8547.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24005.51},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8709.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6184.24,"10th_percentile":6184.24,"90th_percentile":7431.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":17063.98,"10th_percentile":15012.38,"90th_percentile":17112.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16914.17,"10th_percentile":16914.17,"90th_percentile":17372.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10914.7,"10th_percentile":6554.07,"90th_percentile":17875.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"28","median_amount":24168.76,"10th_percentile":20141.59,"90th_percentile":28348.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"24","median_amount":10755.48,"10th_percentile":10052.76,"90th_percentile":12318.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":30050.08,"10th_percentile":30050.08,"90th_percentile":30097.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5411.6,"10th_percentile":5403.55,"90th_percentile":6505.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14758.47,"10th_percentile":13836.34,"90th_percentile":15715.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5871.98,"10th_percentile":5871.98,"90th_percentile":5871.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15332.78,"10th_percentile":15332.78,"90th_percentile":15332.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6069.69,"10th_percentile":6034.86,"90th_percentile":7229.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7245.05,"10th_percentile":7245.05,"90th_percentile":7245.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":10573.28,"10th_percentile":10573.28,"90th_percentile":10573.28},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":5881.98,"10th_percentile":5860.82,"90th_percentile":6538.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":15212.97,"10th_percentile":13225.03,"90th_percentile":38113.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17265.21,"10th_percentile":17265.21,"90th_percentile":17265.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10575.91,"maximum":49936.3,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13755.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14017.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14017.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31440.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13100.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22090.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13461.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25831.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49936.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13886.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31047.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15720.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13100.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14017.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13100.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15720.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43413.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31440.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13755.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44334.32},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14017.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9962.09,"10th_percentile":7409.56,"90th_percentile":10187.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":16041.0,"10th_percentile":16041.0,"90th_percentile":16041.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22905.17,"10th_percentile":22905.17,"90th_percentile":22905.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11068.66,"10th_percentile":7731.57,"90th_percentile":14792.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":23041.32,"10th_percentile":23041.32,"90th_percentile":23041.32},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"23","median_amount":22605.22,"10th_percentile":9463.11,"90th_percentile":26655.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12697.77,"10th_percentile":11806.47,"90th_percentile":14436.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":34293.24,"10th_percentile":28213.34,"90th_percentile":35651.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8729.06,"10th_percentile":6507.44,"90th_percentile":8742.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16133.6,"10th_percentile":14801.07,"90th_percentile":16444.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9447.32,"10th_percentile":9447.32,"90th_percentile":9939.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":40614.45,"10th_percentile":40614.45,"90th_percentile":40614.45},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7847.22,"10th_percentile":7250.95,"90th_percentile":9807.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12510.27,"10th_percentile":12510.27,"90th_percentile":12510.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7519.32,"10th_percentile":5903.13,"90th_percentile":9937.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":17884.22,"10th_percentile":17241.16,"90th_percentile":23300.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9280.22,"maximum":32814.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9744.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22272.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22090.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13461.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25831.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32814.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9837.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21994.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11136.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11136.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28528.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22272.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9744.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29133.67},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":7387.38,"10th_percentile":6162.08,"90th_percentile":9957.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"15","median_amount":15647.22,"10th_percentile":13463.69,"90th_percentile":18403.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19798.1,"10th_percentile":18237.02,"90th_percentile":35453.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"33","median_amount":8837.41,"10th_percentile":6274.38,"90th_percentile":10980.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"154","median_amount":23100.39,"10th_percentile":19540.27,"90th_percentile":23621.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"84","median_amount":12790.85,"10th_percentile":11496.08,"90th_percentile":14331.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":26955.21,"10th_percentile":22656.46,"90th_percentile":33388.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"26","median_amount":6511.47,"10th_percentile":5379.36,"90th_percentile":8860.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"19","median_amount":15203.43,"10th_percentile":14287.97,"90th_percentile":15648.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7028.18,"10th_percentile":5799.65,"90th_percentile":14144.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":33514.23,"10th_percentile":33514.23,"90th_percentile":33514.23},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14960.12,"10th_percentile":14960.12,"90th_percentile":15205.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"18","median_amount":6514.02,"10th_percentile":6021.79,"90th_percentile":7734.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8688.87,"10th_percentile":8588.35,"90th_percentile":9513.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":11296.53,"10th_percentile":11296.53,"90th_percentile":11296.53},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"51","median_amount":7072.75,"10th_percentile":5881.98,"90th_percentile":8206.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"24","median_amount":17199.12,"10th_percentile":13677.34,"90th_percentile":19218.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9573.95,"10th_percentile":9573.95,"90th_percentile":9573.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":16798.6,"10th_percentile":15556.42,"90th_percentile":28071.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8147.18,"maximum":27969.03,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8554.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19553.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10575.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23853.64},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11429.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27893.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27969.03},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8636.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19308.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8147.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8147.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9776.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24315.54},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19553.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8554.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24831.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8717.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"17","median_amount":6447.47,"10th_percentile":6139.9,"90th_percentile":7431.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"15","median_amount":15648.0,"10th_percentile":12586.06,"90th_percentile":19439.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18131.25,"10th_percentile":17524.92,"90th_percentile":18451.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"36","median_amount":8849.49,"10th_percentile":6288.14,"90th_percentile":11219.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"157","median_amount":24374.84,"10th_percentile":21222.51,"90th_percentile":28503.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"103","median_amount":10591.58,"10th_percentile":6416.75,"90th_percentile":12338.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":29191.93,"10th_percentile":26417.56,"90th_percentile":38245.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":5417.65,"10th_percentile":5373.32,"90th_percentile":7037.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"33","median_amount":15158.96,"10th_percentile":12516.88,"90th_percentile":15695.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":6228.02,"10th_percentile":5770.39,"90th_percentile":7498.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":21974.92,"10th_percentile":21974.92,"90th_percentile":21974.92},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12957.85,"10th_percentile":9031.57,"90th_percentile":14063.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"32","median_amount":6536.87,"10th_percentile":6034.86,"90th_percentile":8576.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7535.3,"10th_percentile":7447.61,"90th_percentile":9088.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"69","median_amount":5903.13,"10th_percentile":5860.82,"90th_percentile":7093.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"34","median_amount":17208.66,"10th_percentile":12333.09,"90th_percentile":20124.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":17208.66,"10th_percentile":13820.41,"90th_percentile":18607.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6162.2,"10th_percentile":6162.2,"90th_percentile":6162.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10086.51,"maximum":55712.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14905.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15188.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15188.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15108.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10086.51},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11794.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55712.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15047.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33642.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17034.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14195.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15188.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17034.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48434.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34068.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14905.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49462.48},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15188.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29461.46,"maximum":183730.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46087.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105343.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29461.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43893.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61082.87},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71427.8},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":183730.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46526.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":104026.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52671.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":43893.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46965.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43893.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52671.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":159730.26},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":105343.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46087.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":163118.91},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46965.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9812.03,"10th_percentile":1934.27,"90th_percentile":21577.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":160934.52,"10th_percentile":160934.52,"90th_percentile":160934.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24461.18,"10th_percentile":24461.18,"90th_percentile":24461.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":26101.71,"10th_percentile":21571.08,"90th_percentile":82281.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"15","median_amount":51744.54,"10th_percentile":7747.11,"90th_percentile":77435.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11985.55,"10th_percentile":3395.85,"90th_percentile":83218.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":48440.78,"10th_percentile":44070.87,"90th_percentile":70163.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8545.2,"10th_percentile":2932.4,"90th_percentile":19794.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85214.86,"10th_percentile":85214.86,"90th_percentile":85214.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4582.27,"10th_percentile":4582.27,"90th_percentile":4582.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9632.46,"10th_percentile":4948.85,"90th_percentile":23532.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41687.77,"10th_percentile":41687.77,"90th_percentile":41687.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":13459.08,"10th_percentile":2819.86,"90th_percentile":60950.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":15699.33,"10th_percentile":11178.0,"90th_percentile":20845.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":18883.58,"10th_percentile":18883.58,"90th_percentile":18883.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11331.33,"maximum":125477.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31898.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32505.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32505.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":72909.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11331.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30379.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23493.41},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27472.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125477.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32201.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":71998.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36454.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":30379.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32505.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30379.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36454.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":109086.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":72909.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31898.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":111401.02},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32505.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7923.43,"10th_percentile":6978.83,"90th_percentile":39857.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":51562.04,"10th_percentile":51562.04,"90th_percentile":51562.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":4002.12,"10th_percentile":4002.12,"90th_percentile":4002.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"19","median_amount":14942.49,"10th_percentile":7170.73,"90th_percentile":24087.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8735.41,"10th_percentile":6196.28,"90th_percentile":27683.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8359.73,"10th_percentile":2339.64,"90th_percentile":32612.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11954.0,"10th_percentile":11954.0,"90th_percentile":11954.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8790.07,"10th_percentile":2900.43,"90th_percentile":12027.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45763.76,"10th_percentile":45763.76,"90th_percentile":45763.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":8545.9,"10th_percentile":2547.03,"90th_percentile":21646.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":6099.2,"10th_percentile":6099.2,"90th_percentile":53856.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":7824.77,"10th_percentile":7824.77,"90th_percentile":7824.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3172.77,"maximum":75711.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19776.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45204.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":3172.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6578.16},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6532.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7692.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75711.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19965.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44639.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18835.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20153.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18835.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22602.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":65821.23},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45204.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19776.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67217.61},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20153.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1430.12,"10th_percentile":1113.7,"90th_percentile":2954.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":9195.0,"10th_percentile":9195.0,"90th_percentile":9195.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23459.54,"10th_percentile":23459.54,"90th_percentile":23459.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":2538.22,"10th_percentile":793.2,"90th_percentile":27588.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"42","median_amount":6325.15,"10th_percentile":3871.58,"90th_percentile":6578.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"19","median_amount":6532.78,"10th_percentile":544.0,"90th_percentile":6532.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":7692.22,"10th_percentile":7692.22,"90th_percentile":7692.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":1386.11,"10th_percentile":1040.84,"90th_percentile":6947.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4912.0,"10th_percentile":3692.0,"90th_percentile":75005.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1354.36,"10th_percentile":988.9,"90th_percentile":5704.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":17262.4,"10th_percentile":17262.4,"90th_percentile":17262.4},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"17","median_amount":1404.12,"10th_percentile":1025.23,"90th_percentile":9360.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17759.44,"10th_percentile":17759.44,"90th_percentile":17759.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":6949.56,"10th_percentile":6949.56,"90th_percentile":6949.56},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"48","median_amount":2547.03,"10th_percentile":996.75,"90th_percentile":9100.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":2892.09,"10th_percentile":254.3,"90th_percentile":26082.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":33760.0,"10th_percentile":33760.0,"90th_percentile":33760.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6043.38,"maximum":128892.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32730.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33354.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33354.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74813.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6043.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12529.82},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14651.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128892.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33042.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":73878.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37406.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33354.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31172.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37406.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":112055.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74813.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32730.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":114432.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33354.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3344.35,"10th_percentile":1395.04,"90th_percentile":7923.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34727.21,"10th_percentile":34727.21,"90th_percentile":34727.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":5704.15,"10th_percentile":5704.15,"90th_percentile":6293.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"42","median_amount":10411.01,"10th_percentile":4494.78,"90th_percentile":15192.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"31","median_amount":8810.7,"10th_percentile":5074.85,"90th_percentile":14097.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":14230.74,"10th_percentile":14230.74,"90th_percentile":14230.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":2590.25,"10th_percentile":1282.18,"90th_percentile":8060.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7368.0,"10th_percentile":4745.34,"90th_percentile":43500.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9706.27,"10th_percentile":9706.27,"90th_percentile":9706.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":3283.55,"10th_percentile":1025.23,"90th_percentile":7779.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14299.79,"10th_percentile":14299.79,"90th_percentile":14299.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"23","median_amount":4811.38,"10th_percentile":1331.63,"90th_percentile":8545.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":6919.07,"10th_percentile":3422.66,"90th_percentile":24512.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1919.95,"maximum":45621.96,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28452.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":2424.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5027.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1919.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5879.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45621.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12566.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28097.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11855.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11855.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14226.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39662.54},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28452.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12448.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40503.98},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12685.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"48","median_amount":1144.92,"10th_percentile":1044.22,"90th_percentile":2954.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"20","median_amount":3565.2,"10th_percentile":1194.09,"90th_percentile":6042.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1092.88,"10th_percentile":988.9,"90th_percentile":1436.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"26","median_amount":2061.17,"10th_percentile":200.0,"90th_percentile":2509.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":5027.59,"10th_percentile":5027.59,"90th_percentile":5027.59},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"245","median_amount":4971.0,"10th_percentile":2424.9,"90th_percentile":6397.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"182","median_amount":1919.95,"10th_percentile":1535.96,"90th_percentile":1919.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":6114.22,"10th_percentile":4703.25,"90th_percentile":13522.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"51","median_amount":1223.2,"10th_percentile":915.59,"90th_percentile":2669.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"20","median_amount":4912.0,"10th_percentile":1907.3,"90th_percentile":9658.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":1366.86,"10th_percentile":988.9,"90th_percentile":2843.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":22724.14,"10th_percentile":22724.14,"90th_percentile":22724.14},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6830.56,"10th_percentile":6830.56,"90th_percentile":6830.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"66","median_amount":1369.68,"10th_percentile":1025.23,"90th_percentile":2900.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":11153.86,"10th_percentile":11081.68,"90th_percentile":12089.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3314.0,"10th_percentile":3314.0,"90th_percentile":3314.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"132","median_amount":1331.63,"10th_percentile":996.75,"90th_percentile":2819.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"50","median_amount":3314.0,"10th_percentile":1331.63,"90th_percentile":6628.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":4383.9,"10th_percentile":1202.5,"90th_percentile":5542.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1406.6,"maximum":6490.30,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6490.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":1406.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":2841.14},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1462.0},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3322.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6174.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2866.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6409.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":2704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2704.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3245.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":5368.23},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6490.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2839.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":5482.11},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":2893.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"110","median_amount":1044.22,"10th_percentile":1044.22,"90th_percentile":1113.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"59","median_amount":2580.0,"10th_percentile":915.59,"90th_percentile":3367.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1229.44,"10th_percentile":988.9,"90th_percentile":6756.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"73","median_amount":1387.72,"10th_percentile":264.0,"90th_percentile":1406.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"607","median_amount":2731.86,"10th_percentile":1285.22,"90th_percentile":2841.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"335","median_amount":1462.0,"10th_percentile":1169.6,"90th_percentile":1462.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"25","median_amount":3322.31,"10th_percentile":2657.85,"90th_percentile":3455.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"140","median_amount":915.59,"10th_percentile":915.59,"90th_percentile":1040.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"85","median_amount":4420.79,"10th_percentile":1842.0,"90th_percentile":4912.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"57","median_amount":988.9,"10th_percentile":949.29,"90th_percentile":1354.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":5139.05,"10th_percentile":5139.05,"90th_percentile":5139.05},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1025.23,"10th_percentile":988.9,"90th_percentile":3105.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"165","median_amount":1025.23,"10th_percentile":1025.23,"90th_percentile":1124.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":2452.92,"10th_percentile":2372.39,"90th_percentile":2850.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3135.15,"10th_percentile":3135.15,"90th_percentile":3135.15},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"327","median_amount":996.75,"10th_percentile":996.75,"90th_percentile":1092.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"126","median_amount":3314.0,"10th_percentile":1657.0,"90th_percentile":4676.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"25","median_amount":3250.0,"10th_percentile":1497.28,"90th_percentile":4971.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8460.73,"maximum":39453.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10122.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10315.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10315.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23136.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8460.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9640.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17588.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11875.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20567.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39453.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10218.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22847.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11568.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9640.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10315.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9640.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11568.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34299.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23136.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10122.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35027.35},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10315.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6886.9,"10th_percentile":6886.9,"90th_percentile":6886.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":13585.92,"10th_percentile":13585.92,"90th_percentile":13585.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10628.09,"10th_percentile":10628.09,"90th_percentile":10628.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":8984.49,"10th_percentile":8984.49,"90th_percentile":8984.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8445.5,"maximum":29922.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8867.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9036.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9036.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20269.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8460.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17588.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11875.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20567.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29922.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8952.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20015.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10134.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8445.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9036.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8445.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10134.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26013.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20269.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8867.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26565.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9036.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6467.88,"10th_percentile":6467.88,"90th_percentile":6467.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":6948.54,"10th_percentile":6948.54,"90th_percentile":6948.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":15937.93,"10th_percentile":15937.93,"90th_percentile":15937.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12914.69,"10th_percentile":12914.69,"90th_percentile":12914.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5655.44,"10th_percentile":5655.44,"90th_percentile":5655.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11370.53,"10th_percentile":11370.53,"90th_percentile":11370.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":822.78,"10th_percentile":822.78,"90th_percentile":8919.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6785.46,"10th_percentile":6785.46,"90th_percentile":9246.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8134.99,"maximum":29922.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8541.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19523.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8460.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17588.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11875.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20567.54},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29922.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19279.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8134.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9761.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26013.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19523.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8541.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26565.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8704.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6647.34,"10th_percentile":6647.34,"90th_percentile":6647.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":11212.24,"10th_percentile":11212.24,"90th_percentile":11212.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19294.27,"10th_percentile":19294.27,"90th_percentile":19294.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":8580.41,"10th_percentile":8580.41,"90th_percentile":8580.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":16350.23,"10th_percentile":13847.86,"90th_percentile":19423.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11112.62,"10th_percentile":11112.62,"90th_percentile":11112.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5746.13,"10th_percentile":5746.13,"90th_percentile":5746.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9813.07,"10th_percentile":9813.07,"90th_percentile":9813.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6557.02,"10th_percentile":6557.02,"90th_percentile":6557.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8280.8,"10th_percentile":8280.8,"90th_percentile":8280.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6345.19,"10th_percentile":6195.06,"90th_percentile":6785.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33748.83,"maximum":146937.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35436.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36111.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36111.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80997.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":59697.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33748.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123772.69},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84140.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144734.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146937.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35773.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":79984.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40498.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":33748.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36111.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33748.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40498.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":127743.91},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80997.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35436.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":130453.97},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36111.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":80480.2,"10th_percentile":80480.2,"90th_percentile":80480.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":87210.82,"10th_percentile":87210.82,"90th_percentile":87210.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34917.1,"10th_percentile":34917.1,"90th_percentile":34917.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21418.08,"maximum":101160.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22488.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22917.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22917.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51403.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41724.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86509.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48715.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101160.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90044.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22703.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50760.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25701.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22917.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25701.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":78282.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":51403.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22488.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":79943.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22917.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14960.47,"maximum":85171.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15708.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35905.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35130.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14960.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72835.84},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31047.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":85171.24},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50736.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15858.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35456.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17952.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14960.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14960.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17952.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44109.2},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35905.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15708.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45044.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16007.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29842.0,"maximum":110782.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31334.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":71620.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42212.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29842.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":87520.79},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58329.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102343.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110782.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31632.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":70725.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35810.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":29842.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29842.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35810.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":96311.03},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":71620.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31334.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":98354.25},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31930.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14601.92,"maximum":66882.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15332.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15624.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15624.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35044.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27586.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57195.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32174.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66882.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55007.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15478.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34606.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15624.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14601.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17522.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47822.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35044.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15332.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48836.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15624.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":57112.02,"10th_percentile":57112.02,"90th_percentile":57112.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10995.55,"maximum":54043.37,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11545.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26389.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22290.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10995.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46216.24},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20902.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54043.37},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34165.48},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11655.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26059.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13194.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10995.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10995.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13194.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29702.57},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26389.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11545.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30332.71},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11765.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10274.82,"10th_percentile":10274.82,"90th_percentile":10274.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5868.12,"maximum":30840.1,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21625.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":5868.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12166.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11860.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14226.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30840.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9551.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21355.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9010.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9641.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9010.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10812.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26811.58},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21625.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9461.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27380.38},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9641.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3977.71,"10th_percentile":3977.71,"90th_percentile":3977.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":10099.62,"10th_percentile":10099.62,"90th_percentile":10099.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20568.97,"10th_percentile":20568.97,"90th_percentile":20568.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":5545.62,"10th_percentile":5467.59,"90th_percentile":6269.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"20","median_amount":12535.49,"10th_percentile":10028.39,"90th_percentile":17279.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11760.17,"10th_percentile":6076.84,"90th_percentile":12519.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4538.89,"10th_percentile":4050.04,"90th_percentile":5446.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10653.21,"10th_percentile":10539.24,"90th_percentile":10769.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14760.52,"10th_percentile":14760.52,"90th_percentile":14760.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5469.57,"10th_percentile":4512.66,"90th_percentile":6076.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":4387.31,"10th_percentile":3847.57,"90th_percentile":5908.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":14483.82,"10th_percentile":11440.99,"90th_percentile":19313.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5723.08,"maximum":22359.77,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7146.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7146.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":5723.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11865.74},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11804.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13875.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22359.77},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7079.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15828.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6678.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7146.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6678.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19439.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7012.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19851.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7146.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"30","median_amount":4596.23,"10th_percentile":3977.71,"90th_percentile":4596.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"18","median_amount":10070.4,"10th_percentile":9087.94,"90th_percentile":13288.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14315.72,"10th_percentile":8581.19,"90th_percentile":16918.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"35","median_amount":4192.5,"10th_percentile":1524.07,"90th_percentile":6124.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"221","median_amount":12246.35,"10th_percentile":9573.97,"90th_percentile":12732.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"97","median_amount":10614.23,"10th_percentile":5785.3,"90th_percentile":12463.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":14689.73,"10th_percentile":14653.81,"90th_percentile":15278.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"21","median_amount":4050.04,"10th_percentile":3487.75,"90th_percentile":5446.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"18","median_amount":10099.6,"10th_percentile":8835.9,"90th_percentile":11429.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4329.3,"10th_percentile":3767.01,"90th_percentile":4329.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11321.65,"10th_percentile":10831.55,"90th_percentile":11684.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"34","median_amount":4512.66,"10th_percentile":3905.39,"90th_percentile":4512.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5952.08,"10th_percentile":5911.89,"90th_percentile":6508.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":999.59,"10th_percentile":999.59,"90th_percentile":999.59},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"67","median_amount":4387.31,"10th_percentile":3796.91,"90th_percentile":4765.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"38","median_amount":13200.0,"10th_percentile":7195.32,"90th_percentile":17360.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":16226.59,"10th_percentile":9289.27,"90th_percentile":17813.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4739.52,"maximum":19692.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6411.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14655.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":4739.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9826.51},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11429.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11490.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19692.67},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6472.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7327.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6106.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6106.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7327.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17120.29},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14655.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6411.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17483.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6533.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"76","median_amount":4030.79,"10th_percentile":3665.17,"90th_percentile":4596.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"45","median_amount":10070.4,"10th_percentile":7354.4,"90th_percentile":13288.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6204.88,"10th_percentile":6204.88,"90th_percentile":6204.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":10861.03,"10th_percentile":4589.08,"90th_percentile":14020.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"106","median_amount":4148.29,"10th_percentile":893.34,"90th_percentile":6842.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":17234.74,"10th_percentile":17234.74,"90th_percentile":17234.74},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"506","median_amount":10693.76,"10th_percentile":8228.44,"90th_percentile":13964.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"244","median_amount":10254.75,"10th_percentile":6035.14,"90th_percentile":12088.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"24","median_amount":12305.14,"10th_percentile":7435.43,"90th_percentile":15434.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"96","median_amount":3554.24,"10th_percentile":2991.95,"90th_percentile":4050.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"79","median_amount":10157.2,"10th_percentile":8386.07,"90th_percentile":10769.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"38","median_amount":3987.68,"10th_percentile":3664.35,"90th_percentile":4357.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":9954.77,"10th_percentile":9954.77,"90th_percentile":9954.77},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":9587.62,"10th_percentile":8633.77,"90th_percentile":11007.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"124","median_amount":3957.49,"10th_percentile":3905.39,"90th_percentile":4512.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":6071.7,"10th_percentile":5369.51,"90th_percentile":7030.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"241","median_amount":3847.56,"10th_percentile":3596.66,"90th_percentile":4387.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"95","median_amount":13128.15,"10th_percentile":9496.98,"90th_percentile":17360.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3633.65,"10th_percentile":3633.65,"90th_percentile":3633.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"23","median_amount":13200.0,"10th_percentile":10594.48,"90th_percentile":16808.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17104.64,"maximum":70784.81,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41051.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24431.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17104.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50654.93},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21855.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59233.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70784.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18130.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40538.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17104.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17104.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20525.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":61538.47},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41051.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17959.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":62844.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18301.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17611.85,"10th_percentile":17611.85,"90th_percentile":17611.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24477.2,"10th_percentile":24477.2,"90th_percentile":24477.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17297.97,"10th_percentile":17297.97,"90th_percentile":17333.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":36687.27,"10th_percentile":36687.27,"90th_percentile":36687.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":22055.67,"10th_percentile":22055.67,"90th_percentile":22055.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9793.16,"10th_percentile":9793.16,"90th_percentile":9793.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17215.26,"10th_percentile":17215.26,"90th_percentile":17215.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19367.47,"10th_percentile":19367.47,"90th_percentile":19367.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16830.72,"10th_percentile":16830.72,"90th_percentile":16830.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":14474.89,"10th_percentile":14474.89,"90th_percentile":14474.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10349.43,"maximum":44069.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24838.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18176.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37686.57},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13346.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44069.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38275.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12419.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10349.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10349.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12419.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33276.02},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24838.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10866.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33981.96},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11073.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":30527.72,"10th_percentile":30527.72,"90th_percentile":30527.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21702.16,"10th_percentile":21702.16,"90th_percentile":25465.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":18428.84,"10th_percentile":18428.84,"90th_percentile":18428.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30286.34,"10th_percentile":28887.07,"90th_percentile":37686.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":13545.97,"10th_percentile":11154.13,"90th_percentile":13589.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":18345.4,"10th_percentile":18345.4,"90th_percentile":18345.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":501.5,"10th_percentile":501.5,"90th_percentile":501.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11121.74,"10th_percentile":11121.74,"90th_percentile":11121.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9724.66,"10th_percentile":9662.28,"90th_percentile":10714.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11804.82,"10th_percentile":11804.82,"90th_percentile":11804.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7988.54,"10th_percentile":649.97,"90th_percentile":10196.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9347.79,"10th_percentile":9347.79,"90th_percentile":9347.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8776.81,"maximum":29412.29,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9215.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21064.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16227.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21598.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9844.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25256.14},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29412.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9303.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20801.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8776.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8776.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10532.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25570.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21064.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9215.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26112.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9391.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7485.68,"10th_percentile":7485.68,"90th_percentile":7485.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":21942.84,"10th_percentile":21942.84,"90th_percentile":21942.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9844.85,"10th_percentile":9844.85,"90th_percentile":9844.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19159.18,"10th_percentile":19159.18,"90th_percentile":19159.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9102.37,"10th_percentile":9102.37,"90th_percentile":9102.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11341.92,"maximum":43477.15,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12135.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12135.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27220.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15117.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31343.34},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16112.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36651.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43477.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12022.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26880.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13610.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11341.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12135.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11341.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13610.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37797.9},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27220.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38599.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12135.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10733.72,"10th_percentile":10733.72,"90th_percentile":10967.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12035.34,"10th_percentile":12035.34,"90th_percentile":37751.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2152.31,"10th_percentile":2152.31,"90th_percentile":11203.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27421.37,"10th_percentile":27421.37,"90th_percentile":27421.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15314.32,"10th_percentile":15314.32,"90th_percentile":15410.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10702.59,"10th_percentile":10443.57,"90th_percentile":10920.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":31393.81,"10th_percentile":24966.05,"90th_percentile":32454.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14834.29,"10th_percentile":14462.07,"90th_percentile":16890.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11068.97,"10th_percentile":9386.35,"90th_percentile":12122.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12306.88,"10th_percentile":12306.88,"90th_percentile":12306.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11086.48,"10th_percentile":11086.48,"90th_percentile":11086.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11109.43,"10th_percentile":11027.6,"90th_percentile":12384.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10946.5,"10th_percentile":10946.5,"90th_percentile":10946.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10877.15,"10th_percentile":10877.15,"90th_percentile":10877.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":37190.52,"10th_percentile":37190.52,"90th_percentile":37190.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"23","median_amount":10168.17,"10th_percentile":3618.15,"90th_percentile":10933.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7856.03,"maximum":28522.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8405.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8405.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18854.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11754.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7856.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24370.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9110.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28497.86},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28522.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8327.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18618.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9427.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7856.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8405.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7856.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9427.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24796.48},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18854.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25322.53},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8405.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7025.93,"10th_percentile":429.17,"90th_percentile":7467.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7367.96,"10th_percentile":7367.96,"90th_percentile":7367.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6121.12,"10th_percentile":2948.55,"90th_percentile":7683.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14052.56,"10th_percentile":14052.56,"90th_percentile":17419.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":8865.06,"10th_percentile":4610.98,"90th_percentile":11726.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8032.27,"10th_percentile":7359.43,"90th_percentile":8067.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"16","median_amount":22834.75,"10th_percentile":18971.06,"90th_percentile":25979.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"14","median_amount":8060.42,"10th_percentile":7258.2,"90th_percentile":9741.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1893.36,"10th_percentile":1893.36,"90th_percentile":1893.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23213.21,"10th_percentile":23213.21,"90th_percentile":23213.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":7549.86,"10th_percentile":411.01,"90th_percentile":7780.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14235.21,"10th_percentile":12506.27,"90th_percentile":21930.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5249.39,"10th_percentile":1455.7,"90th_percentile":11057.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8250.24,"10th_percentile":8250.24,"90th_percentile":8250.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":380.6,"10th_percentile":380.6,"90th_percentile":380.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"14","median_amount":5658.31,"10th_percentile":5103.58,"90th_percentile":7556.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":7468.02,"10th_percentile":1177.98,"90th_percentile":8181.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":10458.01,"10th_percentile":10458.01,"90th_percentile":12854.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7450.69,"10th_percentile":7266.96,"90th_percentile":9988.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12209.63,"maximum":49178.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12820.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13064.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13064.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29303.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20284.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42056.34},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16481.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49178.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47837.85},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12942.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28936.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12209.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13064.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14651.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41588.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29303.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12820.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":42471.28},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13064.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10810.2,"10th_percentile":10810.2,"90th_percentile":10810.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12347.58,"10th_percentile":12347.58,"90th_percentile":12347.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":840.78,"10th_percentile":840.78,"90th_percentile":27854.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":20481.4,"10th_percentile":18294.85,"90th_percentile":20536.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11493.91,"10th_percentile":11493.91,"90th_percentile":11493.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":42472.44,"10th_percentile":6158.45,"90th_percentile":75105.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16681.74,"10th_percentile":13894.83,"90th_percentile":16681.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9155.98,"10th_percentile":9155.98,"90th_percentile":51916.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":27638.01,"10th_percentile":27638.01,"90th_percentile":27638.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11078.5,"10th_percentile":7861.0,"90th_percentile":17988.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25247.08,"10th_percentile":25247.08,"90th_percentile":25247.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12733.97,"10th_percentile":12733.97,"90th_percentile":12733.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13360.44,"10th_percentile":13360.44,"90th_percentile":13360.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":396.94,"10th_percentile":396.94,"90th_percentile":396.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11328.88,"10th_percentile":810.11,"90th_percentile":12781.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":42058.79,"10th_percentile":42058.79,"90th_percentile":42058.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11100.46,"10th_percentile":11100.46,"90th_percentile":11100.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16522.34,"maximum":64600.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17348.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39653.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19982.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41429.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19142.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48446.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64600.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17513.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39157.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19826.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16522.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16522.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19826.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56162.18},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39653.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17348.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57353.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17678.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11322.94,"10th_percentile":11322.94,"90th_percentile":11322.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6319.39,"10th_percentile":6319.39,"90th_percentile":6319.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8543.03,"maximum":37483.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9141.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9141.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20503.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15460.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32054.41},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11576.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37483.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31402.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9055.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20246.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10251.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8543.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9141.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8543.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10251.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27300.57},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20503.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8970.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27879.75},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9141.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":421.15,"10th_percentile":421.15,"90th_percentile":421.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":12612.5,"10th_percentile":12612.5,"90th_percentile":12612.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2193.18,"10th_percentile":2193.18,"90th_percentile":2193.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":27270.37,"10th_percentile":27270.37,"90th_percentile":27270.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5803.65,"maximum":29267.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6093.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6209.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6209.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12071.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25028.32},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8360.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29267.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20378.76},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6151.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13754.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5803.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6209.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5803.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17716.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6093.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18092.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6209.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8924.99,"10th_percentile":8924.99,"90th_percentile":8924.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":21744.24,"10th_percentile":21744.24,"90th_percentile":21744.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8492.45,"maximum":78347.27,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18867.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18867.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42319.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8492.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17633.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17607.53},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24895.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20589.52},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78347.27},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41790.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21159.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17633.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18867.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17633.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21159.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":68113.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42319.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18514.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":69558.07},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18867.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11371.2,"10th_percentile":11371.2,"90th_percentile":11371.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5680.77,"maximum":39805.64,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10063.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23002.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":5680.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11778.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13561.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13772.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39805.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10159.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22714.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9584.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9584.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11501.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34605.98},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23002.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10063.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35340.14},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":12540.05,"10th_percentile":12540.05,"90th_percentile":12540.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":36107.91,"10th_percentile":36107.91,"90th_percentile":36107.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6286.62,"maximum":25233.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7958.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7958.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17851.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":6286.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7437.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13034.15},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9269.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15241.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25233.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7884.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17627.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7437.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7958.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7437.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8925.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21937.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17851.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7809.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22403.13},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7958.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8858.71,"10th_percentile":8858.71,"90th_percentile":8858.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":13901.4,"10th_percentile":13901.4,"90th_percentile":13901.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9928.34,"10th_percentile":9928.34,"90th_percentile":9928.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":17043.03,"10th_percentile":17043.03,"90th_percentile":17043.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43328.75,"maximum":179925.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45495.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46361.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46361.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":103989.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67942.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140866.5},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":102479.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164723.49},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":179925.82},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45928.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":102689.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51994.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":43328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46361.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51994.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":156422.81},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":103989.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45495.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":159741.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46361.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45093.31,"10th_percentile":45093.31,"90th_percentile":45093.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9274.7,"10th_percentile":9274.7,"90th_percentile":9274.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17324.79,"maximum":98339.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18191.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18537.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18537.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41579.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40561.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17324.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84097.02},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39238.58},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98339.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68986.14},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18364.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41059.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20789.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17324.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18537.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17324.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20789.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59974.75},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41579.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18191.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":61247.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18537.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17143.24,"10th_percentile":17143.24,"90th_percentile":17143.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9905.54,"maximum":58567.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10400.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23773.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24156.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50084.82},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20180.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58567.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35342.96},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10499.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23476.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9905.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11886.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30726.24},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23773.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10400.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31378.1},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9013.42,"10th_percentile":9013.42,"90th_percentile":9013.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21845.64,"10th_percentile":21845.64,"90th_percentile":21845.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34149.7,"maximum":144610.68,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35857.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36540.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36540.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81959.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53163.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34149.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110224.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54926.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":128892.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":144610.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36198.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80934.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40979.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":34149.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36540.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34149.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40979.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":125720.75},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81959.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35857.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":128387.89},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36540.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":83465.1,"10th_percentile":83465.1,"90th_percentile":83465.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":56542.01,"10th_percentile":56542.01,"90th_percentile":56542.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31782.32,"10th_percentile":31782.32,"90th_percentile":31782.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":107961.76,"10th_percentile":107961.76,"90th_percentile":107961.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":50839.66,"10th_percentile":50839.66,"90th_percentile":50839.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17518.41,"maximum":92174.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":78825.1},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29135.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92174.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67969.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18569.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41518.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21022.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17518.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17518.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21022.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59090.79},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42044.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18394.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60344.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18744.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":539.16,"10th_percentile":539.16,"90th_percentile":539.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43742.68,"10th_percentile":43742.68,"90th_percentile":43742.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3771.11,"10th_percentile":3771.11,"90th_percentile":3771.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16143.83,"10th_percentile":16143.83,"90th_percentile":16143.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":117950.34,"10th_percentile":117950.34,"90th_percentile":117950.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10948.22,"maximum":59343.68,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11495.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26275.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24477.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50748.9},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22294.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59343.68},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38034.78},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11605.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25947.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10948.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10948.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13137.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":33066.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26275.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11495.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33767.95},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11714.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":53130.69,"10th_percentile":53130.69,"90th_percentile":53130.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34816.62,"maximum":147577.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36557.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37253.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37253.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":83559.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":60101.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34816.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":124609.06},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75621.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":145712.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":147577.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36905.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82515.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":34816.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37253.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34816.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":128300.07},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":83559.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36557.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":131021.94},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37253.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47036.11,"10th_percentile":47036.11,"90th_percentile":47036.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":77682.15,"10th_percentile":77682.15,"90th_percentile":77682.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17845.42,"maximum":88753.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18737.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19094.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19094.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42829.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36607.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17845.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75899.38},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31804.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88753.62},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72926.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18916.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42293.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21414.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17845.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19094.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17845.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21414.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":63400.42},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42829.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18737.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":64745.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19094.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":75886.99,"10th_percentile":75886.99,"90th_percentile":75886.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":65486.0,"10th_percentile":65486.0,"90th_percentile":65486.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17958.39,"10th_percentile":17958.39,"90th_percentile":17958.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13489.67,"maximum":55343.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14164.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14433.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14433.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32375.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22827.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13489.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47328.26},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27029.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55343.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49534.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14299.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31970.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16187.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13489.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14433.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13489.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16187.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43064.03},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32375.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14164.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43977.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14433.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11406.63,"10th_percentile":11406.63,"90th_percentile":11406.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":49035.98,"10th_percentile":49035.98,"90th_percentile":49035.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":27679.12,"10th_percentile":27679.12,"90th_percentile":27679.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14623.45,"10th_percentile":14623.45,"90th_percentile":14623.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10693.8,"10th_percentile":10693.8,"90th_percentile":10693.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12694.38,"10th_percentile":12694.38,"90th_percentile":12694.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23932.27,"maximum":95298.66,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25607.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25607.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57437.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37610.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23932.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77979.33},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30022.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91185.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95298.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25368.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":56719.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28718.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":23932.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25607.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23932.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28718.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":82850.16},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57437.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25128.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":84607.82},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25607.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":79243.07,"10th_percentile":79243.07,"90th_percentile":79243.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25797.11,"10th_percentile":25797.11,"90th_percentile":25797.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23204.55,"10th_percentile":23204.55,"90th_percentile":23204.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12064.05,"maximum":60057.96,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12908.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12908.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28953.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24771.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12064.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51359.73},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24105.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60057.96},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45195.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12787.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28591.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12064.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12908.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12064.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39291.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28953.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40125.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12908.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11434.77,"10th_percentile":11434.77,"90th_percentile":11434.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2835.85,"maximum":35568.56,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23747.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":2835.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9894.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5879.62},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5273.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6875.38},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35568.56},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10488.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23450.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9894.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9894.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11873.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":30922.38},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23747.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10389.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31578.39},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10587.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3483.47,"10th_percentile":3483.47,"90th_percentile":5084.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":3989.44,"10th_percentile":3989.44,"90th_percentile":3989.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":6246.84,"10th_percentile":5291.66,"90th_percentile":10985.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":3468.98,"10th_percentile":3468.98,"90th_percentile":4219.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":796.63,"10th_percentile":278.25,"90th_percentile":21891.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2613.39,"10th_percentile":2613.39,"90th_percentile":2613.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3202.99,"10th_percentile":3202.99,"90th_percentile":3325.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":11051.89,"10th_percentile":11051.89,"90th_percentile":11051.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":11173.37,"10th_percentile":11173.37,"90th_percentile":11173.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3039.73,"10th_percentile":3039.73,"90th_percentile":17266.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":1138.59,"10th_percentile":1138.59,"90th_percentile":1138.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"20","median_amount":4911.69,"10th_percentile":3529.35,"90th_percentile":10106.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":4852.61,"10th_percentile":4101.34,"90th_percentile":5126.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4615.94,"10th_percentile":4615.94,"90th_percentile":4615.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8669.3,"10th_percentile":8669.3,"90th_percentile":8669.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3554.89,"10th_percentile":3554.89,"90th_percentile":3554.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2473.92,"10th_percentile":1120.58,"90th_percentile":4512.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2405.2,"10th_percentile":1412.84,"90th_percentile":4853.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":15314.12,"10th_percentile":15314.12,"90th_percentile":15314.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":20331.14,"10th_percentile":20331.14,"90th_percentile":20331.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3412.27,"10th_percentile":3412.27,"90th_percentile":3977.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":2188.16,"10th_percentile":1262.17,"90th_percentile":3202.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"23","median_amount":4378.47,"10th_percentile":3278.75,"90th_percentile":5014.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"14","median_amount":3037.64,"10th_percentile":2597.2,"90th_percentile":3246.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":5279.43,"10th_percentile":5279.43,"90th_percentile":5279.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2209.36,"10th_percentile":1119.35,"90th_percentile":4333.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8118.36,"10th_percentile":6632.0,"90th_percentile":15770.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2969.05,"10th_percentile":2969.05,"90th_percentile":2969.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2770.5,"10th_percentile":2770.5,"90th_percentile":2770.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1120.58,"10th_percentile":1120.58,"90th_percentile":3420.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5102.01,"10th_percentile":5102.01,"90th_percentile":5102.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":6458.89,"10th_percentile":6458.89,"90th_percentile":6458.89},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2405.2,"10th_percentile":1175.32,"90th_percentile":4387.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":14593.86,"10th_percentile":14593.86,"90th_percentile":14625.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":12525.25,"10th_percentile":12525.25,"90th_percentile":12525.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40640.29,"maximum":170808.84,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42672.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43485.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43485.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97536.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":54935.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113899.2},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66927.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133189.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":170808.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":96317.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48768.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":40640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43485.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40640.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48768.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":148496.75},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":97536.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42672.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":151647.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43485.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1682.89,"10th_percentile":1682.89,"90th_percentile":1682.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1133.19,"10th_percentile":1133.19,"90th_percentile":1133.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36752.58,"10th_percentile":36752.58,"90th_percentile":36752.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":49244.82,"10th_percentile":49244.82,"90th_percentile":49244.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":92633.11,"10th_percentile":92633.11,"90th_percentile":92633.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37726.56,"10th_percentile":37726.56,"90th_percentile":37726.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45220.68,"10th_percentile":45220.68,"90th_percentile":45220.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38794.25,"10th_percentile":38794.25,"90th_percentile":38794.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":725.93,"10th_percentile":725.93,"90th_percentile":725.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16229.04,"maximum":93867.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17040.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17365.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17365.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38949.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38716.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80272.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36201.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93867.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66006.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17202.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38462.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19474.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16229.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17365.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16229.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19474.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57384.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38949.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17040.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58602.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17365.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33374.72,"10th_percentile":33374.72,"90th_percentile":33374.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":37970.29,"10th_percentile":37970.29,"90th_percentile":37970.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":34065.27,"10th_percentile":34065.27,"90th_percentile":34065.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15865.37,"10th_percentile":15865.37,"90th_percentile":15865.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10016.69,"maximum":79797.67,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24040.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32913.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68240.53},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20822.75},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79797.67},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39270.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10617.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23739.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10016.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10016.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12020.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34141.17},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24040.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34865.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10717.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":46225.32,"10th_percentile":46225.32,"90th_percentile":46225.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9690.83,"10th_percentile":9690.83,"90th_percentile":9690.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35723.76,"maximum":175045.72,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37509.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38224.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38224.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":85737.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":72200.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35723.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":149693.76},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55387.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":175045.72},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154735.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37867.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":84665.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42868.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":35723.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38224.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35723.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42868.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":134522.7},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":85737.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37509.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":137376.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38224.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":53137.27,"10th_percentile":53137.27,"90th_percentile":53137.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":60248.8,"10th_percentile":60248.8,"90th_percentile":60248.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12736.6,"maximum":109592.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17052.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17377.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17377.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38977.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45202.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":93719.92},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12736.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109592.22},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62678.43},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17214.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38490.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16240.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17377.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16240.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54490.99},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38977.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17052.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55647.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17377.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10596.28,"maximum":87837.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24469.39,"maximum":98568.41,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25692.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26182.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26182.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58726.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32413.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24469.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51510.09},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33490.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60233.78},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98568.41},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25937.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57992.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29363.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24469.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26182.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24469.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29363.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85692.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58726.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25692.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87510.76},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26182.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23320.33,"10th_percentile":23320.33,"90th_percentile":23320.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":534.33,"10th_percentile":534.33,"90th_percentile":534.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10270.0,"10th_percentile":10270.0,"90th_percentile":10270.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":51926.19,"10th_percentile":51633.8,"90th_percentile":52606.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":33690.39,"10th_percentile":33690.39,"90th_percentile":33690.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14261.76,"10th_percentile":14261.76,"90th_percentile":14261.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":953.81,"10th_percentile":953.81,"90th_percentile":23507.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56341.59,"10th_percentile":56341.59,"90th_percentile":56341.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":85112.32,"10th_percentile":85112.32,"90th_percentile":85112.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22851.56,"10th_percentile":22851.56,"90th_percentile":22851.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12970.48,"maximum":49647.81,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13619.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31129.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24844.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42457.3},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23115.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49647.81},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48455.95},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13748.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30740.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12970.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":42126.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31129.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13619.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":43020.04},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13878.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":638.97,"10th_percentile":638.97,"90th_percentile":638.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":278.77,"10th_percentile":278.77,"90th_percentile":278.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":43383.4,"10th_percentile":41156.85,"90th_percentile":53057.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50368.26,"10th_percentile":50368.26,"90th_percentile":50368.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10383.1,"10th_percentile":10383.1,"90th_percentile":10383.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12158.2,"10th_percentile":12158.2,"90th_percentile":13448.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":848.42,"10th_percentile":848.42,"90th_percentile":848.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":430.53,"10th_percentile":430.53,"90th_percentile":430.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8517.21,"maximum":44644.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20441.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18414.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38178.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18324.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44644.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32505.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9028.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20185.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8517.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8517.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28259.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20441.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28859.29},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9113.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15576.47,"maximum":59856.49,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16355.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16666.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16666.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37383.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24688.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15576.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial 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Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12250.56,"10th_percentile":12250.56,"90th_percentile":12250.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33716.74,"10th_percentile":33716.74,"90th_percentile":33716.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24632.41,"10th_percentile":24632.41,"90th_percentile":24632.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":81559.39,"10th_percentile":81559.39,"90th_percentile":81559.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17058.01,"10th_percentile":17058.01,"90th_percentile":17058.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12224.02,"10th_percentile":12224.02,"90th_percentile":12224.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29647.53,"10th_percentile":29647.53,"90th_percentile":29647.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14835.53,"10th_percentile":14835.53,"90th_percentile":14835.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15074.36,"10th_percentile":15074.36,"90th_percentile":15074.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10001.63,"maximum":45431.74,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed 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Plans","methodology":"fee schedule","standard_charge_dollar":38851.84},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18872.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45431.74},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36934.57},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10601.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23703.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12001.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va 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schedule","standard_charge_dollar":24003.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10501.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32791.15},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10701.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21961.87,"10th_percentile":21961.87,"90th_percentile":21961.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":37273.33,"10th_percentile":37273.33,"90th_percentile":37273.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1449.74,"10th_percentile":1449.74,"90th_percentile":1449.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7378.44,"maximum":35398.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17708.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14600.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7378.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30272.05},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14833.93},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35398.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25858.21},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7821.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17486.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7378.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7378.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8854.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22480.46},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17708.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7747.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22957.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7894.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14833.93,"10th_percentile":14833.93,"90th_percentile":14833.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19862.66,"maximum":78919.01,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21253.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21253.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24963.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19862.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51757.55},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20086.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60523.15},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78919.01},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21054.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47074.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":19862.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21253.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19862.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":68610.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":47670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":70065.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21253.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":7042.54,"10th_percentile":7042.54,"90th_percentile":7042.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18264.36,"10th_percentile":18264.36,"90th_percentile":18264.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":51757.55,"10th_percentile":51757.55,"90th_percentile":51757.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":20086.38,"10th_percentile":20086.38,"90th_percentile":20086.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12336.94,"10th_percentile":12336.94,"90th_percentile":12336.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10652.77,"maximum":39267.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":32251.76},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12534.5},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37713.88},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39267.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11291.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25247.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12783.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11185.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34862.72},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11398.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15555.65,"10th_percentile":15555.65,"90th_percentile":18268.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9533.99,"10th_percentile":9470.31,"90th_percentile":10670.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30617.33,"10th_percentile":22219.71,"90th_percentile":32251.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"13","median_amount":12534.5,"10th_percentile":10866.82,"90th_percentile":12534.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7846.18,"10th_percentile":7846.18,"90th_percentile":12336.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37400.54,"10th_percentile":37400.54,"90th_percentile":37400.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19752.79,"10th_percentile":19752.79,"90th_percentile":19752.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9612.15,"10th_percentile":9612.15,"90th_percentile":9807.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9726.87,"10th_percentile":9726.87,"90th_percentile":9726.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7362.66,"maximum":33391.58,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13772.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7362.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28555.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7951.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33391.58},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25308.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7804.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17449.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8835.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7362.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7362.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8835.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":22002.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17670.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":22468.98},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7878.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12729.65,"10th_percentile":12729.65,"90th_percentile":12729.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19131.82,"maximum":82544.16,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21736.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49684.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19131.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39666.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46453.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46384.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":82544.16},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21943.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49062.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24842.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22150.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20701.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24842.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":71761.74},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49684.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21736.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":73284.15},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22150.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46827.1,"maximum":284675.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66538.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67805.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67805.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":152087.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46827.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97087.31},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51565.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113529.91},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":284675.23},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67172.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":150186.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76043.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":63369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67805.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63369.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76043.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":247489.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":152087.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66538.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":252739.65},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67805.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36686.85,"maximum":154571.36,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38521.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":88048.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48044.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36686.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99612.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57357.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116482.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":154571.36},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38888.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":86947.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44024.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":36686.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36686.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44024.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":134380.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":88048.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38521.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":137231.16},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39254.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26369.84,"10th_percentile":1428.95,"90th_percentile":35941.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":51531.67,"10th_percentile":51531.67,"90th_percentile":51531.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":124792.6,"10th_percentile":124792.6,"90th_percentile":124792.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":36087.46,"10th_percentile":29195.27,"90th_percentile":38823.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":85754.51,"10th_percentile":71992.75,"90th_percentile":115615.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"11","median_amount":48380.85,"10th_percentile":46150.02,"90th_percentile":69454.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":34397.1,"10th_percentile":29703.54,"90th_percentile":35090.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":97235.77,"10th_percentile":97235.77,"90th_percentile":97235.77},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"29","median_amount":92923.86,"10th_percentile":46846.94,"90th_percentile":114006.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"11","median_amount":58142.92,"10th_percentile":55814.18,"90th_percentile":60068.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":68393.33,"10th_percentile":68393.33,"90th_percentile":68393.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":43703.14,"10th_percentile":23655.9,"90th_percentile":45044.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":90041.56,"10th_percentile":90041.56,"90th_percentile":106846.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":46810.95,"10th_percentile":46810.95,"90th_percentile":46810.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"50","median_amount":34583.76,"10th_percentile":18379.78,"90th_percentile":37361.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":78504.22,"10th_percentile":77707.42,"90th_percentile":84160.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":50395.36,"10th_percentile":50395.36,"90th_percentile":50395.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":36075.5,"10th_percentile":35495.32,"90th_percentile":44117.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":59648.65,"10th_percentile":59648.65,"90th_percentile":59648.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34578.23,"10th_percentile":34578.23,"90th_percentile":34815.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2427.64,"10th_percentile":2427.64,"90th_percentile":2427.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":49068.67,"10th_percentile":48893.1,"90th_percentile":49322.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":97234.15,"10th_percentile":52513.35,"90th_percentile":348219.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"43","median_amount":35537.13,"10th_percentile":15740.43,"90th_percentile":36936.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":132770.46,"10th_percentile":77488.39,"90th_percentile":142570.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36897.68,"10th_percentile":12372.2,"90th_percentile":37343.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15600.14,"maximum":61754.37,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16380.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37440.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24173.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15600.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50119.28},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24278.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58607.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61754.37},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16536.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36972.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18720.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15600.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15600.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18720.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":53687.64},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37440.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16380.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":54826.61},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16692.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15390.23,"10th_percentile":15390.23,"90th_percentile":15390.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19929.71,"10th_percentile":19929.71,"90th_percentile":19929.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":32956.73,"10th_percentile":32956.73,"90th_percentile":32956.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15448.78,"10th_percentile":15448.78,"90th_percentile":15830.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35938.44,"10th_percentile":32179.23,"90th_percentile":38143.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24193.35,"10th_percentile":24193.35,"90th_percentile":24193.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14716.22,"10th_percentile":14706.89,"90th_percentile":14779.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"17","median_amount":46028.44,"10th_percentile":37783.47,"90th_percentile":66263.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":25117.27,"10th_percentile":23592.58,"90th_percentile":25479.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47455.88,"10th_percentile":32402.7,"90th_percentile":63505.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":48804.98,"10th_percentile":48804.98,"90th_percentile":48804.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16554.14,"10th_percentile":13752.43,"90th_percentile":16936.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":40157.89,"10th_percentile":40157.89,"90th_percentile":40157.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14922.7,"10th_percentile":14922.7,"90th_percentile":14922.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17831.46,"10th_percentile":17831.46,"90th_percentile":17831.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":16196.59,"10th_percentile":7930.54,"90th_percentile":25809.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":54772.9,"10th_percentile":54772.9,"90th_percentile":54772.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14460.98,"10th_percentile":13083.12,"90th_percentile":15982.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18298.51,"10th_percentile":18298.51,"90th_percentile":18298.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12008.12,"maximum":54944.46,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12848.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12848.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28819.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22662.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12008.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46986.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24648.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54944.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50236.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12728.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28459.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12008.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12848.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12008.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14409.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43673.93},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28819.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12608.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44600.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12848.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21975.24,"10th_percentile":21975.24,"90th_percentile":21975.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33890.82,"maximum":139421.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35585.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36263.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36263.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81337.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":48044.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33890.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":99612.07},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43054.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":116482.26},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":139421.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35924.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":80321.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40668.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":33890.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36263.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33890.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40668.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":121209.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":81337.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35585.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":123781.05},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36263.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1973.56,"10th_percentile":1973.56,"90th_percentile":1973.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":49147.18,"10th_percentile":49147.18,"90th_percentile":49147.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30922.27,"10th_percentile":30922.27,"90th_percentile":30922.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":132893.1,"10th_percentile":132893.1,"90th_percentile":132893.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":44523.75,"10th_percentile":44523.75,"90th_percentile":44523.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21736.07,"10th_percentile":14646.32,"90th_percentile":22015.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28530.49,"10th_percentile":28530.49,"90th_percentile":28530.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7425.41,"10th_percentile":7425.41,"90th_percentile":7425.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32421.64,"10th_percentile":30264.21,"90th_percentile":34953.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16628.48,"maximum":67338.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17459.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17792.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17792.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22662.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16628.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46986.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21431.2},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54944.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67338.9},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17626.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39409.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16628.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17792.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16628.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19954.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":58542.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17459.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59784.66},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17792.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7756.82,"10th_percentile":7756.82,"90th_percentile":7756.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":65124.56,"10th_percentile":65124.56,"90th_percentile":65124.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":22595.16,"10th_percentile":21357.06,"90th_percentile":22853.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":46324.89,"10th_percentile":39799.06,"90th_percentile":64798.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":21799.09,"10th_percentile":21799.09,"90th_percentile":21799.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14296.89,"10th_percentile":14296.89,"90th_percentile":14650.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16208.43,"10th_percentile":16208.43,"90th_percentile":16208.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":347.19,"10th_percentile":347.19,"90th_percentile":347.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":61447.34,"10th_percentile":61447.34,"90th_percentile":61447.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15609.37,"10th_percentile":15609.37,"90th_percentile":15609.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11260.17,"maximum":76907.59,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11823.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12048.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12048.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27024.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31721.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11260.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65769.03},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19175.85},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76907.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39818.0},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11935.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26686.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11260.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12048.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11260.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13512.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34616.73},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27024.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11823.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35351.12},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12048.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9084.65,"10th_percentile":9084.65,"90th_percentile":9084.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":53768.29,"10th_percentile":53768.29,"90th_percentile":53768.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41311.4,"10th_percentile":41311.4,"90th_percentile":41311.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10529.4,"10th_percentile":10529.4,"90th_percentile":10529.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14349.49,"maximum":56821.93,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34438.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23348.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14349.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48408.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16288.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56607.45},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56821.93},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15210.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34008.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17219.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14349.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14349.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17219.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49399.5},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34438.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15066.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50447.51},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15353.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8510.46,"10th_percentile":8510.46,"90th_percentile":8510.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12736.78,"10th_percentile":12736.78,"90th_percentile":12736.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32240.43,"10th_percentile":32240.43,"90th_percentile":32240.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12580.54,"10th_percentile":12580.54,"90th_percentile":12580.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":46650.19,"10th_percentile":40859.02,"90th_percentile":49539.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16488.24,"10th_percentile":16472.47,"90th_percentile":16531.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":156.12,"10th_percentile":156.12,"90th_percentile":156.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54456.18,"10th_percentile":54456.18,"90th_percentile":57050.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13996.99,"10th_percentile":12880.05,"90th_percentile":17248.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14618.46,"10th_percentile":13967.34,"90th_percentile":14689.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":40223.14,"10th_percentile":40223.14,"90th_percentile":40223.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12045.66,"10th_percentile":11400.86,"90th_percentile":13769.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8427.57,"maximum":38680.9,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20226.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15954.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8427.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33078.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9853.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38680.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30901.91},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8933.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19973.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10113.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8427.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8427.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10113.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26865.31},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20226.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8848.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27435.26},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9017.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8026.01,"10th_percentile":8026.01,"90th_percentile":8026.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15954.51,"10th_percentile":15954.51,"90th_percentile":65126.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7890.06,"10th_percentile":7890.06,"90th_percentile":7890.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":16522.86,"10th_percentile":11256.85,"90th_percentile":40035.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10096.87,"10th_percentile":10096.87,"90th_percentile":10096.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31629.9,"10th_percentile":31629.9,"90th_percentile":31629.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":417.18,"10th_percentile":417.18,"90th_percentile":417.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13581.51,"10th_percentile":13581.51,"90th_percentile":13581.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8002.59,"10th_percentile":8002.59,"90th_percentile":8002.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8538.03,"10th_percentile":8538.03,"90th_percentile":8538.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":28291.23,"10th_percentile":28291.23,"90th_percentile":28291.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7434.63,"10th_percentile":7204.44,"90th_percentile":10124.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7637.31,"maximum":30182.82,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8171.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8171.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18329.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12449.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25811.43},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8119.48},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30182.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27749.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18100.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7637.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8171.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7637.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9164.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24124.78},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18329.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8019.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24636.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8171.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23645.45,"10th_percentile":23366.38,"90th_percentile":25220.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":7073.76,"10th_percentile":7073.76,"90th_percentile":8119.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12200.07,"10th_percentile":12200.07,"90th_percentile":12200.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5623.2,"10th_percentile":5623.2,"90th_percentile":5623.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":25314.79,"10th_percentile":25314.79,"90th_percentile":25314.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":578.56,"10th_percentile":578.56,"90th_percentile":578.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":24959.94,"10th_percentile":24959.94,"90th_percentile":24959.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12016.01,"maximum":45612.69,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12616.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28838.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18241.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37821.26},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14656.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44226.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45612.69},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12736.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28477.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12016.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12016.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14419.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":39654.48},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28838.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12616.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":40495.74},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12857.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":29918.13,"10th_percentile":29918.13,"90th_percentile":29918.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29858.24,"10th_percentile":29858.24,"90th_percentile":29858.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6279.08,"maximum":27571.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7882.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18018.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11372.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23577.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6279.08},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27571.13},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27341.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7957.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17792.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9009.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7507.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7507.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9009.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23770.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18018.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7882.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24274.4},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8033.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":11643.0,"10th_percentile":11643.0,"90th_percentile":11643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":11368.09,"10th_percentile":11368.09,"90th_percentile":11368.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":30830.27,"10th_percentile":30830.27,"90th_percentile":40123.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5183.13,"10th_percentile":5183.13,"90th_percentile":5183.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4947.23,"10th_percentile":4947.23,"90th_percentile":4947.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7253.41,"10th_percentile":7253.41,"90th_percentile":7253.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5752.65,"10th_percentile":5752.65,"90th_percentile":5752.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7826.3,"10th_percentile":7826.3,"90th_percentile":7826.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16282.11,"maximum":80478.98,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17096.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17421.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17421.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39077.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33194.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68823.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17594.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80478.98},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66266.5},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17259.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38588.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19538.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16282.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17421.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16282.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19538.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57610.37},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":39077.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17096.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58832.56},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17421.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":85520.18,"10th_percentile":85520.18,"90th_percentile":85520.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17794.37,"10th_percentile":17794.37,"90th_percentile":17794.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16046.91,"10th_percentile":16046.91,"90th_percentile":16046.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15998.35,"10th_percentile":15998.35,"90th_percentile":15998.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8196.88,"maximum":55889.5,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20797.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23052.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8665.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47795.0},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8196.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55889.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32450.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9185.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20537.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8665.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8665.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10398.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28211.4},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20797.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28809.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9272.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20093.63,"10th_percentile":20093.63,"90th_percentile":20093.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8396.72,"10th_percentile":8396.72,"90th_percentile":35646.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":26794.96,"10th_percentile":26794.96,"90th_percentile":26794.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6504.27,"maximum":49856.6,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6959.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6959.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15610.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20564.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6504.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42635.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11863.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49856.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22236.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6894.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15415.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6504.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6959.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6504.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7805.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":19331.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15610.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6829.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":19741.64},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6959.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50836.92,"maximum":214990.63,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53378.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54395.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54395.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":122008.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52879.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50836.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59203.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91530.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69230.02},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":214990.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53887.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":120483.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61004.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":50836.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54395.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50836.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61004.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":186907.24},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":122008.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53378.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":190872.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54395.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":95625.11,"10th_percentile":95625.11,"90th_percentile":95625.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1970.76,"10th_percentile":1133.0,"90th_percentile":48674.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":116665.99,"10th_percentile":109893.77,"90th_percentile":120042.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":56496.47,"10th_percentile":56496.47,"90th_percentile":56496.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34331.83,"10th_percentile":33182.66,"90th_percentile":72779.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":91980.91,"10th_percentile":91980.91,"90th_percentile":91980.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":91730.72,"10th_percentile":91730.72,"90th_percentile":91774.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":48008.18,"10th_percentile":40968.32,"90th_percentile":50416.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22307.53,"10th_percentile":22307.53,"90th_percentile":22307.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":49300.86,"10th_percentile":37256.79,"90th_percentile":51977.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49107.1,"10th_percentile":49107.1,"90th_percentile":49107.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":187374.37,"10th_percentile":187374.37,"90th_percentile":187374.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":48877.86,"10th_percentile":33017.92,"90th_percentile":52209.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15201.42,"maximum":60644.88,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15961.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36483.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37771.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15201.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35709.99},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22217.03},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41757.79},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60644.88},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16113.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36027.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18241.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15201.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15201.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18241.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52723.08},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36483.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15961.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53841.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16265.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"64","median_amount":13290.31,"10th_percentile":7393.02,"90th_percentile":14738.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"15","median_amount":22537.95,"10th_percentile":12070.82,"90th_percentile":51055.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"11","median_amount":25822.04,"10th_percentile":12994.57,"90th_percentile":75568.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"76","median_amount":14148.85,"10th_percentile":653.04,"90th_percentile":15287.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"46","median_amount":34462.57,"10th_percentile":284.84,"90th_percentile":35985.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"68","median_amount":35595.1,"10th_percentile":15247.78,"90th_percentile":46583.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"82","median_amount":14289.78,"10th_percentile":9170.84,"90th_percentile":15426.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":32739.57,"10th_percentile":32739.57,"90th_percentile":32739.57},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"114","median_amount":35988.06,"10th_percentile":22472.83,"90th_percentile":56021.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"64","median_amount":22416.87,"10th_percentile":19728.47,"90th_percentile":26560.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":42080.34,"10th_percentile":24141.41,"90th_percentile":54597.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"15","median_amount":10562.51,"10th_percentile":2112.02,"90th_percentile":19793.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":48125.26,"10th_percentile":1526.65,"90th_percentile":61328.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3593.84,"10th_percentile":3593.84,"90th_percentile":3593.84},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":20523.85,"10th_percentile":7304.21,"90th_percentile":23022.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"271","median_amount":13106.72,"10th_percentile":3013.4,"90th_percentile":15213.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":29412.74,"10th_percentile":833.79,"90th_percentile":32093.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"19","median_amount":11851.35,"10th_percentile":8468.04,"90th_percentile":22324.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":341.19,"10th_percentile":341.19,"90th_percentile":341.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"111","median_amount":14847.82,"10th_percentile":14408.57,"90th_percentile":16004.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":13757.46,"10th_percentile":13757.46,"90th_percentile":13757.46},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15104.58,"10th_percentile":15088.99,"90th_percentile":16006.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":14076.84,"10th_percentile":511.08,"90th_percentile":14217.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":15125.65,"10th_percentile":591.43,"90th_percentile":16886.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"25","median_amount":13333.92,"10th_percentile":4346.92,"90th_percentile":24386.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"25","median_amount":40490.9,"10th_percentile":22118.52,"90th_percentile":54181.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"237","median_amount":13457.16,"10th_percentile":7644.72,"90th_percentile":14867.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":39839.82,"10th_percentile":18323.03,"90th_percentile":53254.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"27","median_amount":13888.76,"10th_percentile":8503.69,"90th_percentile":15206.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8609.72,"maximum":31863.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9040.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20663.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18130.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26312.62},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11662.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30768.9},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31863.06},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9126.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20405.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8609.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8609.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27700.91},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20663.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9040.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":28288.58},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9212.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":6518.87,"10th_percentile":5899.98,"90th_percentile":8986.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7996.35,"10th_percentile":7996.35,"90th_percentile":12041.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":30381.01,"10th_percentile":20743.83,"90th_percentile":61052.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":7329.85,"10th_percentile":355.74,"90th_percentile":8858.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":17578.94,"10th_percentile":423.55,"90th_percentile":21790.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"25","median_amount":17484.47,"10th_percentile":10154.32,"90th_percentile":25673.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7202.16,"10th_percentile":7137.12,"90th_percentile":8102.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"49","median_amount":25480.84,"10th_percentile":16418.31,"90th_percentile":28142.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"31","median_amount":10566.88,"10th_percentile":9330.14,"90th_percentile":11906.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":42879.89,"10th_percentile":42879.89,"90th_percentile":46989.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7130.82,"10th_percentile":7015.96,"90th_percentile":12725.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"13","median_amount":26542.18,"10th_percentile":20072.65,"90th_percentile":32279.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":6507.56,"10th_percentile":6507.56,"90th_percentile":6507.56},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10981.28,"10th_percentile":10981.28,"90th_percentile":10981.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"34","median_amount":6867.9,"10th_percentile":438.36,"90th_percentile":9156.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16289.54,"10th_percentile":15546.48,"90th_percentile":19640.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7850.96,"10th_percentile":1561.42,"90th_percentile":11851.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":8289.82,"10th_percentile":8111.7,"90th_percentile":9381.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8450.4,"10th_percentile":8450.4,"90th_percentile":8450.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7907.96,"10th_percentile":7907.96,"90th_percentile":7907.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":338.56,"10th_percentile":338.56,"90th_percentile":338.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7661.22,"10th_percentile":4221.84,"90th_percentile":25322.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"13","median_amount":18707.27,"10th_percentile":6328.36,"90th_percentile":28066.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"39","median_amount":7232.26,"10th_percentile":636.29,"90th_percentile":9022.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":28066.26,"10th_percentile":28066.26,"90th_percentile":28066.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8006.22,"10th_percentile":8006.22,"90th_percentile":8006.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31365.87,"maximum":136915.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32934.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33561.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33561.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75278.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43110.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31365.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89381.47},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78758.8},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104519.01},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":136915.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33247.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74337.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37639.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31365.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33561.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31365.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37639.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":119030.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75278.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32934.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":121555.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33561.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32014.55,"10th_percentile":32014.55,"90th_percentile":32014.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15000.63,"maximum":68171.42,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15750.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16050.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16050.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36001.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28118.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15000.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58298.12},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26856.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68171.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58639.15},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15900.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35551.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18000.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15000.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16050.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15000.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18000.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":50979.34},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36001.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15750.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":52060.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16050.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14707.96,"10th_percentile":14707.96,"90th_percentile":14707.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":25638.34,"10th_percentile":25638.34,"90th_percentile":25638.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":44434.79,"10th_percentile":44434.79,"90th_percentile":44434.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7488.89,"10th_percentile":7488.89,"90th_percentile":7488.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9658.85,"maximum":54819.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10141.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10334.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10334.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23181.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22611.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9658.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46880.32},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21513.98},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54819.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37673.2},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10238.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22891.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11590.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9658.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10334.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9658.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11590.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":32752.09},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23181.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10141.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":33446.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10334.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9548.73,"10th_percentile":9548.73,"90th_percentile":9548.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27611.78,"maximum":119321.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28992.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29544.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29544.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66268.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38142.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27611.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79081.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65337.43},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92475.19},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119321.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29268.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65439.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27611.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29544.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27611.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33134.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":103734.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66268.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28992.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":105935.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29544.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11909.16,"maximum":58336.36,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28581.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24061.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49887.48},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27314.68},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58336.36},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50934.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12623.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28224.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11909.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14290.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44281.15},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":28581.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12504.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45220.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12742.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14810.8,"maximum":67447.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16125.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36858.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14810.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15357.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30707.46},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19399.45},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35908.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67447.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16279.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36397.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18429.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15357.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15357.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18429.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":58636.72},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36858.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16125.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":59880.69},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16432.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14924.46,"10th_percentile":14924.46,"90th_percentile":14924.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28803.62,"maximum":123110.07,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30819.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30819.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69128.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":46881.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28803.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97200.08},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48942.6},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":113661.77},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123110.07},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30531.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":68264.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34564.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":28803.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30819.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28803.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34564.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":107028.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69128.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":109299.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30819.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":45497.0,"10th_percentile":45497.0,"90th_percentile":45497.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":549.31,"10th_percentile":549.31,"90th_percentile":549.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":60392.53,"10th_percentile":60392.53,"90th_percentile":94784.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":51735.49,"10th_percentile":51735.49,"90th_percentile":51735.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33134.91,"10th_percentile":29738.8,"90th_percentile":55332.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":50615.86,"10th_percentile":50615.86,"90th_percentile":50615.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29192.3,"10th_percentile":29192.3,"90th_percentile":29192.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":33730.66,"10th_percentile":33730.66,"90th_percentile":49284.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28756.53,"10th_percentile":27081.37,"90th_percentile":28884.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27741.89,"10th_percentile":27741.89,"90th_percentile":29661.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15579.34,"maximum":80090.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16358.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37390.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33034.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15579.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68491.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23493.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80090.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62335.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16514.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36923.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18695.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15579.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15579.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18695.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":54192.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37390.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16358.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":55342.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16669.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15948.18,"10th_percentile":15948.18,"90th_percentile":15948.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":32935.78,"10th_percentile":32498.09,"90th_percentile":33127.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14896.16,"10th_percentile":14896.16,"90th_percentile":14896.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":68907.23,"10th_percentile":68907.23,"90th_percentile":68907.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23471.91,"10th_percentile":23471.91,"90th_percentile":23471.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14999.85,"10th_percentile":14999.85,"90th_percentile":14999.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14785.13,"10th_percentile":14785.13,"90th_percentile":14785.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":55991.26,"10th_percentile":55991.26,"90th_percentile":55991.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15158.27,"10th_percentile":15158.27,"90th_percentile":15158.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10685.04,"maximum":51691.75,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11219.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11432.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11432.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25644.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21321.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10685.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44205.2},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14001.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51691.75},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39193.72},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25323.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12822.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10685.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11432.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10685.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12822.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34074.0},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25644.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11219.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":34796.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11432.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":45702.07,"10th_percentile":45702.07,"90th_percentile":45702.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":15020.87,"10th_percentile":15020.87,"90th_percentile":15020.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19667.41,"10th_percentile":19667.41,"90th_percentile":19667.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10019.5,"10th_percentile":10019.5,"90th_percentile":10019.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12993.43,"maximum":50010.47,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13902.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13902.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31184.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16061.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12993.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33301.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24307.9},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38940.97},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50010.47},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13773.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30794.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15592.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12993.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13902.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12993.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15592.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":43477.8},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31184.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13643.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44400.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13902.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7621.54,"maximum":28318.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18291.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10409.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21582.61},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11419.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25237.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28318.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8078.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18063.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7621.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7621.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9145.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24619.15},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18291.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8002.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25141.44},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8155.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":21284.24,"10th_percentile":21284.24,"90th_percentile":21284.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":10955.73,"10th_percentile":10955.73,"90th_percentile":10955.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5689.52,"10th_percentile":5689.52,"90th_percentile":5689.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":464.05,"10th_percentile":464.05,"90th_percentile":464.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13083.91,"maximum":53706.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13996.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14263.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14263.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31993.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13083.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13330.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27127.06},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15539.13},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31721.27},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53706.71},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14130.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31593.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13330.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14263.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13330.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15996.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46691.21},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31993.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13996.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47681.76},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14263.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13260.84,"10th_percentile":13260.84,"90th_percentile":13260.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10193.95,"10th_percentile":10193.95,"90th_percentile":10193.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6014.94,"10th_percentile":6014.94,"90th_percentile":6014.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30739.04,"10th_percentile":30739.04,"90th_percentile":30739.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12870.91,"10th_percentile":12870.91,"90th_percentile":12870.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":26339.41,"10th_percentile":26339.41,"90th_percentile":27471.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":15055.94,"10th_percentile":15055.94,"90th_percentile":15543.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12814.96,"10th_percentile":12814.96,"90th_percentile":12814.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22735.6,"10th_percentile":22735.6,"90th_percentile":22735.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13217.72,"10th_percentile":13217.72,"90th_percentile":13217.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5485.73,"maximum":20520.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6473.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6473.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14519.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":7533.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6049.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12495.36},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5485.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14611.56},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20520.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6412.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14337.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7259.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6049.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6473.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6049.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7259.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":17840.35},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14519.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6352.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18218.83},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6473.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8712.21,"10th_percentile":8712.21,"90th_percentile":8712.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":55527.32,"10th_percentile":55527.32,"90th_percentile":55527.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":15785.8,"10th_percentile":15785.8,"90th_percentile":15785.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":12657.71,"10th_percentile":9969.39,"90th_percentile":23450.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5645.6,"10th_percentile":5645.6,"90th_percentile":5645.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7617.61,"10th_percentile":7617.61,"90th_percentile":7617.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1003.22,"10th_percentile":1003.22,"90th_percentile":1003.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5971.28,"10th_percentile":5971.28,"90th_percentile":5971.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4109.64,"10th_percentile":4109.64,"90th_percentile":5731.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12518.7,"maximum":50671.84,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30044.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17702.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25692.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15655.23},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30043.63},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50671.84},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13269.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29669.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12518.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15022.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44052.77},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30044.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13144.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":44987.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13395.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10988.65,"10th_percentile":10988.65,"90th_percentile":10988.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":25245.27,"10th_percentile":25245.27,"90th_percentile":33390.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12610.55,"10th_percentile":12610.55,"90th_percentile":13143.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"15","median_amount":29255.49,"10th_percentile":20541.81,"90th_percentile":31692.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"18","median_amount":16573.55,"10th_percentile":9779.93,"90th_percentile":26219.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10268.54,"10th_percentile":10268.54,"90th_percentile":10268.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":24157.7,"10th_percentile":16471.56,"90th_percentile":29378.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":14876.56,"10th_percentile":11159.17,"90th_percentile":16069.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":29147.64,"10th_percentile":28925.73,"90th_percentile":56923.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10024.78,"10th_percentile":10024.78,"90th_percentile":16008.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47783.08,"10th_percentile":47783.08,"90th_percentile":47783.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":10816.6,"10th_percentile":9259.21,"90th_percentile":12808.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25705.42,"10th_percentile":18613.72,"90th_percentile":25880.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7977.37,"10th_percentile":7977.37,"90th_percentile":14674.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12642.39,"10th_percentile":12536.16,"90th_percentile":13209.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7854.09,"10th_percentile":2351.78,"90th_percentile":17417.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":25620.12,"10th_percentile":662.78,"90th_percentile":44721.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12721.24,"10th_percentile":12721.24,"90th_percentile":12721.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":10776.6,"10th_percentile":10067.36,"90th_percentile":13109.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7318.94,"10th_percentile":7318.94,"90th_percentile":7318.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7417.88,"maximum":27332.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7788.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17802.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10403.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7417.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10785.04},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8326.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12611.59},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27332.38},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7862.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17580.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8901.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7417.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7417.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8901.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23762.06},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17802.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7788.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24266.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7937.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1824.25,"10th_percentile":1824.25,"90th_percentile":1824.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12182.02,"10th_percentile":12182.02,"90th_percentile":13636.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":7866.22,"10th_percentile":2759.17,"90th_percentile":10979.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":10371.6,"10th_percentile":9056.45,"90th_percentile":11201.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8570.37,"10th_percentile":6856.3,"90th_percentile":10493.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24112.72,"10th_percentile":24112.72,"90th_percentile":24112.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2723.64,"10th_percentile":544.27,"90th_percentile":6556.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2268.74,"10th_percentile":2268.74,"90th_percentile":2268.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7096.77,"10th_percentile":7096.77,"90th_percentile":7096.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2059.81,"10th_percentile":2059.81,"90th_percentile":2059.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":24486.07,"10th_percentile":24486.07,"90th_percentile":24486.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5585.25,"10th_percentile":5585.25,"90th_percentile":5585.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7431.1,"10th_percentile":7431.1,"90th_percentile":7431.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14400.41,"maximum":56352.18,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34560.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19384.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40189.4},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16593.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46995.83},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56352.18},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15264.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34128.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17280.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":14400.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14400.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17280.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48991.11},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34560.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50030.45},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15408.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11869.34,"10th_percentile":11869.34,"90th_percentile":12345.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13027.81,"10th_percentile":13027.81,"90th_percentile":13027.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27789.34,"10th_percentile":27789.34,"90th_percentile":31947.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":14673.17,"10th_percentile":14673.17,"90th_percentile":14673.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13495.11,"10th_percentile":13495.11,"90th_percentile":13495.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":28150.71,"10th_percentile":26803.67,"90th_percentile":40533.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":16793.54,"10th_percentile":14838.05,"90th_percentile":16817.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":33268.56,"10th_percentile":33268.56,"90th_percentile":33268.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11782.12,"10th_percentile":11782.12,"90th_percentile":11782.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":9756.89,"10th_percentile":9756.89,"90th_percentile":9756.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14014.09,"10th_percentile":14014.09,"90th_percentile":14014.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":20118.4,"10th_percentile":20118.4,"90th_percentile":20118.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":28779.41,"10th_percentile":28779.41,"90th_percentile":49361.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13941.98,"10th_percentile":13941.98,"90th_percentile":35476.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13759.51,"10th_percentile":13759.51,"90th_percentile":13759.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8459.12,"maximum":35886.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8882.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20301.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14801.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30688.66},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11763.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35886.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31393.3},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8966.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20048.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8459.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8459.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10150.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27292.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20301.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8882.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27871.52},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21584.13,"10th_percentile":21584.13,"90th_percentile":21584.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":13785.25,"10th_percentile":13785.25,"90th_percentile":13785.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":413.12,"10th_percentile":413.12,"90th_percentile":413.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":15871.21,"10th_percentile":11674.42,"90th_percentile":32341.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":11375.74,"10th_percentile":5410.97,"90th_percentile":11963.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":22991.83,"10th_percentile":22991.83,"90th_percentile":22991.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23170.58,"10th_percentile":23170.58,"90th_percentile":23778.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8235.47,"10th_percentile":8235.47,"90th_percentile":8235.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7185.7,"10th_percentile":5865.52,"90th_percentile":8429.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8270.46,"10th_percentile":8270.46,"90th_percentile":8963.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8148.62,"10th_percentile":8148.62,"90th_percentile":8148.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6208.11,"maximum":26010.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14899.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10728.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22243.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6317.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26010.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21250.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6580.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14713.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7449.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":6208.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7449.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":18474.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":14899.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6518.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":18866.37},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6642.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20964.48,"10th_percentile":14218.28,"90th_percentile":22659.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":722.78,"10th_percentile":722.78,"90th_percentile":722.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6131.96,"10th_percentile":6131.96,"90th_percentile":6131.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13816.68,"maximum":52204.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14507.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33160.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17129.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35515.77},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15162.88},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41530.69},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52204.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14645.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32745.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16580.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13816.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16580.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":45385.43},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33160.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14507.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":46348.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14783.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":26591.83,"10th_percentile":26591.83,"90th_percentile":26591.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10379.51,"10th_percentile":10379.51,"90th_percentile":10379.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12843.7,"10th_percentile":12843.7,"90th_percentile":12843.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13003.34,"10th_percentile":13003.34,"90th_percentile":13003.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16383.43,"10th_percentile":16383.43,"90th_percentile":16383.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8569.56,"maximum":31516.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8998.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9169.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9169.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20566.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":10683.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8569.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22149.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9809.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25900.82},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31516.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9083.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20309.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10283.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8569.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9169.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8569.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10283.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":27399.99},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20566.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8998.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27981.27},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9169.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8404.6,"10th_percentile":8404.6,"90th_percentile":8404.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":10460.11,"10th_percentile":10460.11,"90th_percentile":10460.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1100.45,"10th_percentile":1100.45,"90th_percentile":1100.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14658.57,"10th_percentile":14658.57,"90th_percentile":14658.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":60.0,"10th_percentile":60.0,"90th_percentile":60.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":154378.73,"maximum":733153.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162097.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165185.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165185.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":370508.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":185897.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154378.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":385423.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":450698.42},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":733153.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":163641.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":365877.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185254.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":154378.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165185.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154378.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":185254.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":637384.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":370508.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":162097.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":650906.19},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":165185.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52707.87,"maximum":206399.04,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56397.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56397.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":126498.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66410.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52707.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":137690.19},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":161009.25},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":206399.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55870.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":124917.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63249.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":52707.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56397.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52707.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":63249.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":179437.94},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":126498.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55343.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":183244.68},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":56397.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24368.28,"maximum":98284.08,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25586.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58483.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":35554.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24368.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73716.06},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":86200.53},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98284.08},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25830.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":57752.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29241.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":24368.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26074.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24368.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29241.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85445.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":58483.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25586.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87258.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26074.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29197.32,"maximum":133716.66,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30657.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31241.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31241.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":70073.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40227.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29197.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83404.75},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52757.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":97530.08},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":133716.66},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30949.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69197.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35036.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":29197.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31241.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29197.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35036.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":116249.78},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":70073.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30657.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":118715.99},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31241.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10868.09,"10th_percentile":10868.09,"90th_percentile":10868.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17124.0,"maximum":66312.86,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17980.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41097.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20766.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17124.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43055.59},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50347.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66312.86},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":40583.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20548.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":17124.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17124.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20548.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":57650.67},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":41097.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17980.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":58873.72},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18322.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7562.02,"10th_percentile":7562.02,"90th_percentile":7562.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16044.03,"maximum":67876.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38505.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":17533.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16044.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36352.14},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42508.7},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67876.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17006.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38024.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16044.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16044.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19252.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":59010.19},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38505.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":60262.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17167.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27291.95,"maximum":98086.29,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28656.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29202.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29202.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65500.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32743.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27291.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67886.56},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55423.78},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79383.76},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":98086.29},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28929.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":64681.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32750.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":27291.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29202.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27291.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32750.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":85273.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":65500.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28656.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":87082.72},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29202.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16205.04,"10th_percentile":16205.04,"90th_percentile":16205.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18029.72,"maximum":65249.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18931.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19291.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19291.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43271.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25416.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52697.29},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32673.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61622.04},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65249.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19111.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":42730.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18029.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19291.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18029.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21635.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":56726.41},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43271.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18931.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":57929.85},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19291.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":63884.95,"10th_percentile":63884.95,"90th_percentile":63884.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16270.94,"10th_percentile":16270.94,"90th_percentile":16270.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15812.4,"maximum":60394.55,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20443.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42385.25},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21029.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49563.57},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60394.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16761.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37475.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18974.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15812.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18974.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":52505.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":37949.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16603.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":53619.34},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16919.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12376.71,"maximum":47173.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12995.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13243.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13243.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16626.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12376.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34472.67},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40310.92},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47173.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13119.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29332.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14852.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12376.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13243.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12376.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14852.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":41011.32},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29704.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12995.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41881.36},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13243.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9495.35,"maximum":37153.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10160.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10160.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15324.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31772.49},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37153.44},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34502.34},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10065.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22503.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10160.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9495.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11394.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":29995.44},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22788.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9970.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":30631.78},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10160.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10374.53,"maximum":39746.92,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24898.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13245.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10374.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27462.23},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17258.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32113.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39746.92},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10997.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24587.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10374.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10374.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":34554.93},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24898.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":35288.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":23967.63,"10th_percentile":23967.63,"90th_percentile":23967.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10265.44,"10th_percentile":10265.44,"90th_percentile":10265.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":28344.12,"10th_percentile":28344.12,"90th_percentile":28344.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17258.05,"10th_percentile":17258.05,"90th_percentile":17258.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":16969.23,"10th_percentile":16969.23,"90th_percentile":16969.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29330.78,"10th_percentile":29330.78,"90th_percentile":29330.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9036.99,"10th_percentile":9036.99,"90th_percentile":10089.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19414.81,"10th_percentile":19414.81,"90th_percentile":19414.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":229.15,"10th_percentile":229.15,"90th_percentile":229.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":22651.07,"10th_percentile":22651.07,"90th_percentile":22651.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8950.52,"10th_percentile":8950.52,"90th_percentile":8950.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7011.99,"maximum":24554.02,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7362.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7502.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7502.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16828.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9883.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20492.52},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12027.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23963.11},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24554.02},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7432.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16618.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7011.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7502.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7011.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8414.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":21346.63},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":16828.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7362.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":21799.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7502.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6567.04,"10th_percentile":6567.04,"90th_percentile":6567.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6734.94,"10th_percentile":6734.94,"90th_percentile":6734.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12285.29,"10th_percentile":12285.29,"90th_percentile":12285.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":12793.57,"10th_percentile":12793.57,"90th_percentile":12793.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":20908.62,"10th_percentile":644.56,"90th_percentile":31094.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":8423.84,"10th_percentile":8423.84,"90th_percentile":8423.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":129.13,"10th_percentile":129.13,"90th_percentile":129.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6505.1,"10th_percentile":6505.1,"90th_percentile":6505.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5959.58,"10th_percentile":5959.58,"90th_percentile":5959.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5454.03,"10th_percentile":5454.03,"90th_percentile":5454.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6639.02,"10th_percentile":6639.02,"90th_percentile":6639.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4809.79,"10th_percentile":2763.32,"90th_percentile":6159.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9802.99,"maximum":33343.4,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10293.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23527.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":11063.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22938.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21620.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26823.89},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33343.4},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10391.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23233.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9802.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9802.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11763.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":28987.89},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23527.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10293.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":29602.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10489.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6168.76,"10th_percentile":6168.76,"90th_percentile":6168.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5772.82,"maximum":21787.31,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6061.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6176.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6176.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13854.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":8986.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5772.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18631.84},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13152.63},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21787.31},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18113.42},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6119.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13681.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5772.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6176.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5772.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6927.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15747.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13854.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6061.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":16081.41},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6176.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3286.28,"maximum":22377.05,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5626.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5626.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12620.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":9229.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5258.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19136.17},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3286.28},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22377.05},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17520.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5574.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12463.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6310.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5258.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5626.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5258.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6310.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":15231.47},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":12620.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5521.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":15554.6},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5626.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5178.63,"10th_percentile":5178.63,"90th_percentile":5178.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":9608.22,"10th_percentile":9608.22,"90th_percentile":9608.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1111.59,"10th_percentile":1111.59,"90th_percentile":1111.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":7951.58,"10th_percentile":4987.16,"90th_percentile":8871.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":3486.12,"10th_percentile":3486.12,"90th_percentile":3486.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7240.44,"10th_percentile":7240.44,"90th_percentile":7240.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4902.14,"10th_percentile":4675.73,"90th_percentile":5458.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5504.07,"10th_percentile":5504.07,"90th_percentile":5504.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49541.1,"maximum":211016.25,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53008.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53008.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":118898.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":77095.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49541.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":159842.91},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79340.38},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":186913.73},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":211016.25},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52513.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":117412.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59449.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other 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Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52018.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":187343.92},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53008.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28256.47,"maximum":127668.95,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29669.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30234.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30234.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67815.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52658.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28256.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109178.59},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84127.35},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127668.95},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":118125.09},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29951.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":66967.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33907.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":28256.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30234.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28256.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33907.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":102694.87},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67815.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29669.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":104873.52},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30234.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25689.02,"10th_percentile":25689.02,"90th_percentile":25689.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27795.04,"10th_percentile":27795.04,"90th_percentile":27795.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28421.93,"10th_percentile":28421.93,"90th_percentile":28421.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55914.8,"maximum":230665.65,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58710.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59828.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59828.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":134195.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":87568.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55914.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":181557.09},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103834.25},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":212305.39},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":230665.65},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59269.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":132518.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":55914.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59828.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":55914.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67097.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":200534.69},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":134195.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58710.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":204789.0},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":59828.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":132422.57,"10th_percentile":132422.57,"90th_percentile":132422.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52282.55,"10th_percentile":52282.55,"90th_percentile":52282.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":51884.64,"10th_percentile":51884.64,"90th_percentile":51884.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31489.93,"maximum":164049.51,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33064.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33694.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33694.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75575.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":67664.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":140290.13},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61849.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":164049.51},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":127004.1},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33379.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":74631.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37787.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":31489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33694.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37787.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":110414.05},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":75575.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33064.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":112756.46},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33694.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22384.03,"maximum":135485.71,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23503.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53721.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":55883.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22384.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":115863.25},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40874.73},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135485.71},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81703.55},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23727.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53050.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26860.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":22384.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22384.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26860.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":71030.93},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":53721.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23503.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":72537.84},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23950.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20875.94,"maximum":84193.23,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21919.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22337.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22337.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50102.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":34726.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20875.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71999.48},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46614.15},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84193.23},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83956.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22128.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":49475.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25051.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":20875.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22337.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20875.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25051.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":72989.61},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":50102.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21919.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":74538.07},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22337.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18166.1,"10th_percentile":18166.1,"90th_percentile":18166.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20685.46,"10th_percentile":20685.46,"90th_percentile":20685.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15822.57,"10th_percentile":15822.57,"90th_percentile":15822.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19899.17,"10th_percentile":19899.17,"90th_percentile":19899.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12261.98,"maximum":62325.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13120.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13120.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29428.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25707.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12261.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53298.72},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19380.1},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62325.33},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46363.68},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12997.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29060.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12261.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13120.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12261.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":40307.37},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":29428.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12875.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":41162.49},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13120.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11746.07,"10th_percentile":11746.07,"90th_percentile":11746.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30238.16,"10th_percentile":30238.16,"90th_percentile":30238.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":19296.3,"10th_percentile":19296.3,"90th_percentile":19296.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":69657.05,"10th_percentile":69657.05,"90th_percentile":69657.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":432.91,"10th_percentile":432.91,"90th_percentile":432.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11591.64,"10th_percentile":11591.64,"90th_percentile":11591.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":797.07,"10th_percentile":797.07,"90th_percentile":797.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8015.95,"maximum":51677.1,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19238.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21314.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8015.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44192.68},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15491.83},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51677.1},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28200.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18997.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8015.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8015.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24517.05},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19238.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8416.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25037.18},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8577.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45168.14,"maximum":195440.13,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47426.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":108403.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":77649.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45168.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":160992.52},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54431.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":188258.03},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":195440.13},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47878.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":107048.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54201.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":45168.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48329.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45168.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54201.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":169910.55},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":108403.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47426.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":173515.17},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48329.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. 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Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. 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Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21967.38,"maximum":92282.33,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23065.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23505.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23505.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52721.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32304.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21967.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66978.15},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39120.33},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":78321.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92282.33},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23285.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52062.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26360.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":21967.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23505.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21967.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26360.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":80227.85},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":52721.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23065.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":81929.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23505.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":15240.16,"10th_percentile":15240.16,"90th_percentile":15240.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":50917.5,"10th_percentile":50917.5,"90th_percentile":50917.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":32501.68,"10th_percentile":32501.68,"90th_percentile":32501.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21693.8,"10th_percentile":21693.8,"90th_percentile":21693.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44145.15,"10th_percentile":44145.15,"90th_percentile":44145.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14418.48,"10th_percentile":14418.48,"90th_percentile":33674.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":29724.64,"10th_percentile":29724.64,"90th_percentile":29893.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21709.56,"10th_percentile":21709.56,"90th_percentile":22257.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10558.11,"maximum":58307.06,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25339.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24049.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49862.42},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15514.4},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58307.06},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43925.28},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11191.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25022.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12669.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10558.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12669.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38187.49},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25339.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11086.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38997.63},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11297.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27354.93,"10th_percentile":27354.93,"90th_percentile":27354.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":48527.09,"10th_percentile":48527.09,"90th_percentile":48527.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":15514.4,"10th_percentile":15514.4,"90th_percentile":15514.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10817.25,"10th_percentile":10817.25,"90th_percentile":10817.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10958.77,"10th_percentile":10958.77,"90th_percentile":11128.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7744.88,"maximum":48926.21,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8132.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":20180.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41840.2},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14475.95},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48926.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30994.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8209.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18355.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7744.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9293.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":26945.92},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18587.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8132.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":27517.57},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8287.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":32914.14,"10th_percentile":32914.14,"90th_percentile":32914.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10577.48,"maximum":44558.83,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11106.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":15693.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10577.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32536.81},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25623.7},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38047.21},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44558.83},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11212.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25068.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":10577.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10577.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12692.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38738.28},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":25385.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11106.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39560.11},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11317.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26973.18,"10th_percentile":26973.18,"90th_percentile":26973.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":23291.62,"10th_percentile":23291.62,"90th_percentile":23291.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11158.64,"10th_percentile":11158.64,"90th_percentile":11158.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":504.94,"10th_percentile":504.94,"90th_percentile":504.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26439.77,"maximum":146931.64,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36662.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":83800.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26439.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34917.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54817.96},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56165.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64101.87},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":146931.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37012.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":82753.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41900.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":34917.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34917.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41900.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":127738.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":83800.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36662.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":130448.48},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37361.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32676.82,"10th_percentile":32676.82,"90th_percentile":32676.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":45479.23,"10th_percentile":45479.23,"90th_percentile":45479.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35386.47,"10th_percentile":20328.86,"90th_percentile":37381.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":88674.14,"10th_percentile":81136.76,"90th_percentile":210108.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23539.38,"10th_percentile":7242.12,"90th_percentile":48554.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":69163.66,"10th_percentile":55331.34,"90th_percentile":134066.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":57960.72,"10th_percentile":55658.76,"90th_percentile":60404.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":145000.08,"10th_percentile":145000.08,"90th_percentile":145000.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":32506.99,"10th_percentile":18674.15,"90th_percentile":48094.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74456.93,"10th_percentile":74456.93,"90th_percentile":74456.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":61605.55,"10th_percentile":61605.55,"90th_percentile":61605.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":34061.24,"10th_percentile":31683.95,"90th_percentile":37390.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":191837.22,"10th_percentile":191837.22,"90th_percentile":246703.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":32366.35,"10th_percentile":1990.76,"90th_percentile":34553.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35903.78,"10th_percentile":35903.78,"90th_percentile":37604.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18901.73,"maximum":75670.89,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19846.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20224.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20224.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45364.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24928.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18901.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34457.01},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33759.3},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40292.6},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":75670.89},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44797.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22682.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18901.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20224.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18901.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22682.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":65786.3},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":45364.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19846.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":67181.94},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20224.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16601.09,"10th_percentile":16601.09,"90th_percentile":16601.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":67136.59,"10th_percentile":67136.59,"90th_percentile":67136.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":757.51,"10th_percentile":757.51,"90th_percentile":757.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":44687.77,"10th_percentile":44687.77,"90th_percentile":44687.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":21233.17,"10th_percentile":21233.17,"90th_percentile":21233.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":35900.59,"10th_percentile":35900.59,"90th_percentile":35951.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":33506.69,"10th_percentile":33246.21,"90th_percentile":35495.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17618.24,"10th_percentile":16682.6,"90th_percentile":19666.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21066.3,"10th_percentile":21066.3,"90th_percentile":21066.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":63131.42,"10th_percentile":63131.42,"90th_percentile":63131.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16381.79,"10th_percentile":1583.75,"90th_percentile":18305.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":69144.22,"10th_percentile":69144.22,"90th_percentile":69144.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13562.82,"maximum":54944.46,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14240.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14512.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14512.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32550.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":22662.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46986.83},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21292.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54944.46},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51552.63},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14376.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32143.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16275.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13562.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14512.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13562.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16275.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44818.51},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32550.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14240.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45769.33},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14512.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":278.77,"10th_percentile":278.77,"90th_percentile":278.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":24511.34,"10th_percentile":24511.34,"90th_percentile":24511.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":11744.33,"10th_percentile":11744.33,"90th_percentile":11744.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13988.37,"10th_percentile":13988.37,"90th_percentile":14072.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12482.08,"10th_percentile":12482.08,"90th_percentile":12482.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":866.73,"10th_percentile":866.73,"90th_percentile":866.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25857.01,"maximum":108260.22,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27667.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27667.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62056.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":43059.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89274.97},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42886.05},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104394.47},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":108260.22},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27408.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":61281.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31028.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":25857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27667.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25857.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31028.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":94118.6},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62056.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27149.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":96115.31},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27667.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21657.71,"10th_percentile":21657.71,"90th_percentile":21657.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22890.92,"10th_percentile":22890.92,"90th_percentile":22890.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":56819.96,"10th_percentile":56819.96,"90th_percentile":77689.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24545.75,"10th_percentile":24545.75,"90th_percentile":24545.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":40276.51,"10th_percentile":40276.51,"90th_percentile":40276.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23848.22,"10th_percentile":12263.76,"90th_percentile":26080.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53589.61,"10th_percentile":53589.61,"90th_percentile":53589.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":22798.33,"10th_percentile":22798.33,"90th_percentile":22798.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27561.06,"10th_percentile":27561.06,"90th_percentile":27561.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":58020.2,"10th_percentile":58020.2,"90th_percentile":58020.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25375.9,"10th_percentile":25375.9,"90th_percentile":25375.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13057.97,"maximum":73750.12,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13710.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13972.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13972.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31339.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30419.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13057.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63068.85},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24073.55},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73750.12},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53032.98},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13841.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13057.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13972.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13057.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15669.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":46105.49},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":31339.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13710.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":47083.61},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13972.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11221.91,"10th_percentile":11221.91,"90th_percentile":11221.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":27160.29,"10th_percentile":27160.29,"90th_percentile":27160.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13686.86,"10th_percentile":13686.86,"90th_percentile":13686.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":43883.05,"10th_percentile":43883.05,"90th_percentile":43883.05},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":55054.92,"10th_percentile":55054.92,"90th_percentile":62602.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":22789.2,"10th_percentile":22789.2,"90th_percentile":22789.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55149.5,"10th_percentile":55149.5,"90th_percentile":55149.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11587.06,"10th_percentile":11587.06,"90th_percentile":12041.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14062.72,"10th_percentile":14062.72,"90th_percentile":14062.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":44335.21,"10th_percentile":44335.21,"90th_percentile":44335.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11275.64,"10th_percentile":11275.64,"90th_percentile":11602.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9871.12,"maximum":59742.94,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10364.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23690.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":24641.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9871.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51090.34},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15659.53},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59742.94},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35707.64},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10463.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23394.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":9871.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9871.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11845.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31043.29},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":23690.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10364.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":31701.87},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":23930.6,"10th_percentile":23930.6,"90th_percentile":23930.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":17676.85,"10th_percentile":17676.85,"90th_percentile":17676.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":310941.01,"maximum":1165433.73,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326488.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332706.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332706.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":746258.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310941.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1165433.73},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":329597.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":736930.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373129.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":310941.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332706.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":310941.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":373129.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":1013197.65},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":746258.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":326488.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":1034692.47},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":332706.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28987.2,"maximum":121438.11,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31016.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31016.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69569.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":121438.11},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30726.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":68699.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34784.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":28987.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31016.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28987.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34784.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":105575.12},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":69569.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30436.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":107814.88},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31016.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8157.22,"maximum":29625.53,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8565.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19577.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8157.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29625.53},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8646.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19332.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9788.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8157.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8157.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9788.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25755.66},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19577.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8565.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26302.07},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8728.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4360.97,"10th_percentile":4360.97,"90th_percentile":4360.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20361.22,"10th_percentile":20361.22,"90th_percentile":20361.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":6682.8,"10th_percentile":6682.8,"90th_percentile":6682.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3555.06,"10th_percentile":3555.06,"90th_percentile":3555.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":2478.66,"10th_percentile":2478.66,"90th_percentile":2478.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":4001.47,"10th_percentile":2600.84,"90th_percentile":12204.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5643.33,"10th_percentile":5643.33,"90th_percentile":5643.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":200.0,"10th_percentile":200.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.59,"10th_percentile":135.59,"90th_percentile":135.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5550.22,"10th_percentile":5550.22,"90th_percentile":5550.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14397.97,"10th_percentile":14397.97,"90th_percentile":14397.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7650.33,"10th_percentile":7650.33,"90th_percentile":8082.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6226.48,"10th_percentile":6226.48,"90th_percentile":6226.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2898.88,"10th_percentile":2898.88,"90th_percentile":2898.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8018.82,"maximum":28250.26,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8419.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8580.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8580.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19245.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8018.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28250.26},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8499.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19004.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8018.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8580.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8018.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9622.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":24560.04},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":19245.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8419.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":25081.08},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8580.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8971.86,"maximum":29727.52,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9599.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9599.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21532.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8971.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29727.52},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9510.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21263.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10766.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8971.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9599.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8971.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10766.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":25844.33},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21532.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":26392.61},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9599.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7910.16,"10th_percentile":7910.16,"90th_percentile":7910.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15372.09,"maximum":57372.04,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16448.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16448.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36893.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57372.04},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16294.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36431.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18446.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":15372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16448.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15372.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18446.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":49877.76},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":36893.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16140.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":50935.9},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16448.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12809.13,"maximum":51614.44,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13449.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30741.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51614.44},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13577.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30357.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15370.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":12809.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12809.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15370.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":44872.25},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":30741.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13449.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":45824.2},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13705.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13055.85,"10th_percentile":12967.71,"90th_percentile":13150.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":5001.84,"10th_percentile":5001.84,"90th_percentile":5001.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53075.61,"10th_percentile":53075.61,"90th_percentile":53075.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9933.65,"10th_percentile":581.48,"90th_percentile":12852.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14103.56,"10th_percentile":14103.56,"90th_percentile":14103.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12839.15,"10th_percentile":12839.15,"90th_percentile":12839.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15359.92,"10th_percentile":15359.92,"90th_percentile":15359.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":44245.72,"10th_percentile":44245.72,"90th_percentile":44245.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11288.14,"maximum":43560.6,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11852.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27091.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43560.6},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11965.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":26752.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11288.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13545.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":37870.45},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27091.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11852.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":38673.86},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8525.44,"10th_percentile":8525.44,"90th_percentile":8525.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25557.23,"10th_percentile":25557.23,"90th_percentile":25557.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8618.16,"10th_percentile":8618.16,"90th_percentile":8618.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":5993.31,"10th_percentile":5993.31,"90th_percentile":6879.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":9803.84,"10th_percentile":9803.84,"90th_percentile":9803.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11082.26,"10th_percentile":11082.26,"90th_percentile":11082.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10876.98,"10th_percentile":854.44,"90th_percentile":12264.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16153.75,"maximum":55517.74,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16961.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38769.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16153.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55517.74},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17122.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38284.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19384.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":16153.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16153.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19384.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":48265.68},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":38769.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16961.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":49289.62},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17284.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8951.06,"maximum":36755.32,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9398.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21482.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36755.32},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21214.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10741.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":8951.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8951.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10741.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":31954.11},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":21482.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9398.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":32632.01},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9577.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5695.37,"maximum":19287.81,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13668.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5695.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19287.81},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6037.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13498.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":5695.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5695.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6834.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":16768.32},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":13668.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5980.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":17124.06},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6094.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11422.95,"maximum":44747.35,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11994.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27415.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11422.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44747.35},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12108.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27072.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13707.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":11422.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11422.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13707.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":38902.18},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":27415.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11994.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":39727.48},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12222.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13785.84,"maximum":55035.62,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14750.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14750.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33086.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13785.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55035.62},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14612.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":32672.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16543.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":13785.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14750.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13785.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16543.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":47846.53},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":33086.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14475.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":48861.59},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14750.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11720.75,"10th_percentile":11720.75,"90th_percentile":12701.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13091.46,"10th_percentile":13091.46,"90th_percentile":13836.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28495.01,"10th_percentile":12743.03,"90th_percentile":32038.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":4849.89,"10th_percentile":1797.45,"90th_percentile":62385.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":7509.42,"10th_percentile":7509.42,"90th_percentile":7509.42},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"11","median_amount":4529.79,"10th_percentile":1438.79,"90th_percentile":7762.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":12781.32,"10th_percentile":4438.16,"90th_percentile":18342.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":16988.68,"10th_percentile":16988.68,"90th_percentile":16988.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20439.21,"10th_percentile":20439.21,"90th_percentile":44122.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":24282.54,"10th_percentile":24282.54,"90th_percentile":24282.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32871.07,"10th_percentile":32871.07,"90th_percentile":32871.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28384.2,"10th_percentile":28384.2,"90th_percentile":28384.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8847.82,"10th_percentile":8847.82,"90th_percentile":16050.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13513.49,"10th_percentile":13425.89,"90th_percentile":13925.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5528.09,"10th_percentile":163.93,"90th_percentile":24825.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":32398.07,"10th_percentile":32398.07,"90th_percentile":32398.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13061.93,"10th_percentile":11644.42,"90th_percentile":13409.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":29950.72,"10th_percentile":29950.72,"90th_percentile":29950.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6221.91,"10th_percentile":6221.91,"90th_percentile":6221.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7602.17,"maximum":27264.39,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7982.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18245.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27264.39},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8058.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18017.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":7602.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7602.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9122.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"fee schedule","standard_charge_dollar":23702.95},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":18245.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7982.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"fee schedule","standard_charge_dollar":24205.8},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8134.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5530.29,"10th_percentile":5530.29,"90th_percentile":5530.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6294.86,"10th_percentile":6294.86,"90th_percentile":8967.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"1 through 10","median_amount":11901.19,"10th_percentile":11901.19,"90th_percentile":11901.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5703.99,"10th_percentile":5703.99,"90th_percentile":5703.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13997.41,"10th_percentile":8615.93,"90th_percentile":16992.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"16","median_amount":3452.19,"10th_percentile":559.79,"90th_percentile":11061.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"1 through 10","median_amount":5991.95,"10th_percentile":2231.37,"90th_percentile":11040.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":3926.27,"10th_percentile":2355.51,"90th_percentile":26093.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"1 through 10","median_amount":3933.13,"10th_percentile":3933.13,"90th_percentile":3933.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3354.03,"10th_percentile":3354.03,"90th_percentile":3354.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12478.52,"10th_percentile":871.46,"90th_percentile":20312.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3151.42,"10th_percentile":401.8,"90th_percentile":6987.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14463.87,"10th_percentile":13552.28,"90th_percentile":14703.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"16","median_amount":7853.67,"10th_percentile":7281.97,"90th_percentile":8492.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3448.52,"10th_percentile":3448.52,"90th_percentile":3448.52},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6588.76,"10th_percentile":6588.76,"90th_percentile":6588.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6008.73,"10th_percentile":4862.23,"90th_percentile":6135.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"1 through 10","median_amount":17196.99,"10th_percentile":8316.44,"90th_percentile":22804.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5520.04,"10th_percentile":550.27,"90th_percentile":7178.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"1 through 10","median_amount":22975.93,"10th_percentile":22975.93,"90th_percentile":22975.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bupivacaine liposome","code_information":[{"code":"0763","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6635.79,"10th_percentile":6635.79,"90th_percentile":6635.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15695.11,"10th_percentile":1000.0,"90th_percentile":20025.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6247.47,"10th_percentile":6247.47,"90th_percentile":6247.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23443.29,"10th_percentile":1898.02,"90th_percentile":44480.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13174.86,"10th_percentile":8585.23,"90th_percentile":17342.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6388.49,"10th_percentile":6388.49,"90th_percentile":6388.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":279.88,"10th_percentile":279.88,"90th_percentile":279.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7387.04,"10th_percentile":7387.04,"90th_percentile":7387.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":38022.46,"10th_percentile":38022.46,"90th_percentile":38022.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7694.56,"10th_percentile":7694.56,"90th_percentile":7694.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3108.43,"10th_percentile":3108.43,"90th_percentile":3108.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":50153.1,"10th_percentile":50153.1,"90th_percentile":50153.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":526.14,"10th_percentile":526.14,"90th_percentile":526.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36207.53,"10th_percentile":36207.53,"90th_percentile":36207.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25128.64,"10th_percentile":11301.75,"90th_percentile":69103.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5075.61,"10th_percentile":4916.26,"90th_percentile":18956.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":55076.59,"10th_percentile":55076.59,"90th_percentile":55076.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":44787.95,"10th_percentile":44787.95,"90th_percentile":44787.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1067.71,"10th_percentile":1067.71,"90th_percentile":1067.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7238.37,"10th_percentile":7238.37,"90th_percentile":7238.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14678.94,"10th_percentile":14678.94,"90th_percentile":14678.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2379.14,"10th_percentile":2379.14,"90th_percentile":2379.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":6126.32,"10th_percentile":6126.32,"90th_percentile":6126.32},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":328.0,"10th_percentile":328.0,"90th_percentile":328.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2097.61,"10th_percentile":2097.61,"90th_percentile":2745.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":15694.02,"10th_percentile":15694.02,"90th_percentile":15694.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3042.39,"10th_percentile":3042.39,"90th_percentile":3042.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":40950.29,"10th_percentile":40950.29,"90th_percentile":40950.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1117.1,"10th_percentile":1117.1,"90th_percentile":1182.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2698.98,"10th_percentile":2629.35,"90th_percentile":2804.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82.88,"10th_percentile":82.88,"90th_percentile":82.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1029.48,"10th_percentile":1029.48,"90th_percentile":1029.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":659.91,"10th_percentile":659.91,"90th_percentile":659.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":7123.62,"10th_percentile":7123.62,"90th_percentile":7123.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Albumin (human), 5%, 250 ml","code_information":[{"code":"0963","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9346.66,"10th_percentile":9346.66,"90th_percentile":9346.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endo, single, urinary tract","code_information":[{"code":"2040","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12398.18,"10th_percentile":12398.18,"90th_percentile":12398.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7452.2,"10th_percentile":7452.2,"90th_percentile":7452.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12511.57,"10th_percentile":12511.57,"90th_percentile":12511.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3931.01,"10th_percentile":3931.01,"90th_percentile":3931.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Brachytx, non-str,Yttrium-90","code_information":[{"code":"2616","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17107.31,"10th_percentile":17107.31,"90th_percentile":17107.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30943.0,"10th_percentile":30943.0,"90th_percentile":30943.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18419.79,"10th_percentile":18419.79,"90th_percentile":18419.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23469.49,"10th_percentile":23469.49,"90th_percentile":23469.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":20480.74,"10th_percentile":20480.74,"90th_percentile":20480.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Brachytx, non-stranded,I-125","code_information":[{"code":"2639","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7509.24,"10th_percentile":7509.24,"90th_percentile":7509.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"138","median_amount":121.52,"10th_percentile":119.5,"90th_percentile":121.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"135","median_amount":126.29,"10th_percentile":117.84,"90th_percentile":216.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"65","median_amount":438.8,"10th_percentile":191.92,"90th_percentile":1508.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"108","median_amount":123.64,"10th_percentile":90.73,"90th_percentile":125.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"102","median_amount":118.53,"10th_percentile":107.13,"90th_percentile":281.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"189","median_amount":189.33,"10th_percentile":107.13,"90th_percentile":321.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"128","median_amount":119.23,"10th_percentile":119.23,"90th_percentile":119.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":281.0,"10th_percentile":281.0,"90th_percentile":850.29},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"916","median_amount":335.54,"10th_percentile":224.8,"90th_percentile":1189.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"488","median_amount":86.72,"10th_percentile":58.27,"90th_percentile":232.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"58","median_amount":288.86,"10th_percentile":207.68,"90th_percentile":1131.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"170","median_amount":111.2,"10th_percentile":107.13,"90th_percentile":197.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"89","median_amount":374.0,"10th_percentile":244.8,"90th_percentile":374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"54","median_amount":107.13,"10th_percentile":107.13,"90th_percentile":246.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"289","median_amount":123.85,"10th_percentile":123.85,"90th_percentile":123.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":338.3,"10th_percentile":338.3,"90th_percentile":338.3},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"46","median_amount":418.5,"10th_percentile":11.13,"90th_percentile":569.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"210","median_amount":115.7,"10th_percentile":84.02,"90th_percentile":213.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"267","median_amount":119.23,"10th_percentile":119.23,"90th_percentile":119.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":166.92,"10th_percentile":155.0,"90th_percentile":338.3},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":117.84,"10th_percentile":117.84,"90th_percentile":117.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":115.7,"10th_percentile":115.7,"90th_percentile":115.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"410","median_amount":118.04,"10th_percentile":112.49,"90th_percentile":206.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"172","median_amount":157.0,"10th_percentile":151.0,"90th_percentile":558.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"220","median_amount":121.52,"10th_percentile":107.13,"90th_percentile":121.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"36","median_amount":156.07,"10th_percentile":151.0,"90th_percentile":885.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":107.13,"10th_percentile":85.83,"90th_percentile":125.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":192.14,"10th_percentile":142.14,"90th_percentile":419.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"125","median_amount":310.12,"10th_percentile":175.43,"90th_percentile":584.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"21","median_amount":1228.45,"10th_percentile":600.58,"90th_percentile":2256.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":272.98,"10th_percentile":149.76,"90th_percentile":306.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"60","median_amount":356.57,"10th_percentile":245.18,"90th_percentile":566.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"62","median_amount":250.0,"10th_percentile":90.5,"90th_percentile":752.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":259.64,"10th_percentile":146.51,"90th_percentile":483.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1068.19,"10th_percentile":1068.19,"90th_percentile":1068.19},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"226","median_amount":951.9,"10th_percentile":266.72,"90th_percentile":1952.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"106","median_amount":320.09,"10th_percentile":115.89,"90th_percentile":755.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":915.31,"10th_percentile":250.0,"90th_percentile":2497.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"95","median_amount":281.93,"10th_percentile":159.48,"90th_percentile":587.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"24","median_amount":1252.76,"10th_percentile":936.59,"90th_percentile":1442.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":504.2,"10th_percentile":504.2,"90th_percentile":504.2},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"30","median_amount":343.69,"10th_percentile":200.69,"90th_percentile":578.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"52","median_amount":247.64,"10th_percentile":163.02,"90th_percentile":421.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1713.12,"10th_percentile":1713.12,"90th_percentile":1713.12},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"44","median_amount":586.44,"10th_percentile":524.65,"90th_percentile":1011.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"126","median_amount":304.48,"10th_percentile":172.24,"90th_percentile":580.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":215.83,"10th_percentile":215.83,"90th_percentile":215.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1543.76,"10th_percentile":1543.76,"90th_percentile":1543.76},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":259.64,"10th_percentile":259.64,"90th_percentile":259.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":117.84,"10th_percentile":117.84,"90th_percentile":117.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":767.2,"10th_percentile":767.2,"90th_percentile":767.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"313","median_amount":262.64,"10th_percentile":167.46,"90th_percentile":576.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"39","median_amount":690.48,"10th_percentile":186.58,"90th_percentile":1153.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.58,"10th_percentile":186.58,"90th_percentile":186.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"53","median_amount":264.64,"10th_percentile":151.94,"90th_percentile":349.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":921.21,"10th_percentile":350.0,"90th_percentile":1316.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":322.41,"10th_percentile":322.41,"90th_percentile":2618.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"207","median_amount":394.49,"10th_percentile":253.91,"90th_percentile":759.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"502","median_amount":373.15,"10th_percentile":215.85,"90th_percentile":707.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"215","median_amount":2239.3,"10th_percentile":1027.26,"90th_percentile":4814.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"229","median_amount":389.9,"10th_percentile":264.75,"90th_percentile":685.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"724","median_amount":550.09,"10th_percentile":98.01,"90th_percentile":1065.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"747","median_amount":526.84,"10th_percentile":90.5,"90th_percentile":1511.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"211","median_amount":401.93,"10th_percentile":260.51,"90th_percentile":697.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"15","median_amount":1605.32,"10th_percentile":1294.17,"90th_percentile":3592.3},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"2333","median_amount":1961.82,"10th_percentile":627.54,"90th_percentile":4134.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1096","median_amount":565.0,"10th_percentile":235.84,"90th_percentile":1171.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"146","median_amount":1594.77,"10th_percentile":500.0,"90th_percentile":3710.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"427","median_amount":290.78,"10th_percentile":196.23,"90th_percentile":598.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"348","median_amount":2494.37,"10th_percentile":699.6,"90th_percentile":5288.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":542.56,"10th_percentile":542.56,"90th_percentile":663.6},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"136","median_amount":388.93,"10th_percentile":200.69,"90th_percentile":647.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"792","median_amount":386.94,"10th_percentile":175.15,"90th_percentile":708.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3915.11,"10th_percentile":1890.56,"90th_percentile":9211.9},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"428","median_amount":958.57,"10th_percentile":823.57,"90th_percentile":1693.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"468","median_amount":379.78,"10th_percentile":211.93,"90th_percentile":694.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":374.04,"10th_percentile":374.04,"90th_percentile":530.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":300.0,"10th_percentile":150.0,"90th_percentile":553.05},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"325","median_amount":420.25,"10th_percentile":369.3,"90th_percentile":757.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"12","median_amount":1000.0,"10th_percentile":500.16,"90th_percentile":3122.58},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":746.89,"10th_percentile":682.89,"90th_percentile":883.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":487.05,"10th_percentile":362.53,"90th_percentile":678.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":409.37,"10th_percentile":324.17,"90th_percentile":886.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1265","median_amount":352.46,"10th_percentile":206.05,"90th_percentile":651.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"445","median_amount":2058.28,"10th_percentile":270.0,"90th_percentile":4124.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.58,"10th_percentile":186.58,"90th_percentile":1115.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"844","median_amount":378.91,"10th_percentile":263.71,"90th_percentile":702.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"131","median_amount":1793.51,"10th_percentile":186.58,"90th_percentile":3704.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"80","median_amount":408.47,"10th_percentile":264.75,"90th_percentile":772.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"466","median_amount":778.36,"10th_percentile":430.83,"90th_percentile":1147.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"437","median_amount":575.21,"10th_percentile":259.88,"90th_percentile":776.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"345","median_amount":4713.47,"10th_percentile":2068.2,"90th_percentile":8026.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"517","median_amount":778.06,"10th_percentile":389.75,"90th_percentile":1154.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1103","median_amount":902.8,"10th_percentile":188.32,"90th_percentile":1697.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1173","median_amount":1310.8,"10th_percentile":151.81,"90th_percentile":3011.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"465","median_amount":754.8,"10th_percentile":529.5,"90th_percentile":1126.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"22","median_amount":4903.06,"10th_percentile":3126.7,"90th_percentile":7233.15},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"3341","median_amount":4422.15,"10th_percentile":1999.05,"90th_percentile":7704.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1635","median_amount":1363.96,"10th_percentile":703.2,"90th_percentile":2239.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"215","median_amount":3841.41,"10th_percentile":685.53,"90th_percentile":7203.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"412","median_amount":545.99,"10th_percentile":246.49,"90th_percentile":715.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"475","median_amount":4825.97,"10th_percentile":2144.71,"90th_percentile":6271.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":794.86,"10th_percentile":765.66,"90th_percentile":926.74},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"136","median_amount":530.15,"10th_percentile":248.31,"90th_percentile":664.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1632","median_amount":716.89,"10th_percentile":385.46,"90th_percentile":1165.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":6067.63,"10th_percentile":4935.85,"90th_percentile":8339.77},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"479","median_amount":2219.55,"10th_percentile":1324.71,"90th_percentile":3348.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"401","median_amount":582.95,"10th_percentile":283.91,"90th_percentile":743.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":619.65,"10th_percentile":543.68,"90th_percentile":1225.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":556.52,"10th_percentile":325.0,"90th_percentile":1100.79},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"648","median_amount":819.57,"10th_percentile":507.09,"90th_percentile":1232.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"18","median_amount":1327.85,"10th_percentile":240.86,"90th_percentile":4735.54},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":746.39,"10th_percentile":496.84,"90th_percentile":1069.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":724.01,"10th_percentile":497.56,"90th_percentile":929.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"62","median_amount":717.77,"10th_percentile":503.68,"90th_percentile":1063.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1147","median_amount":566.77,"10th_percentile":248.08,"90th_percentile":704.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"717","median_amount":3345.77,"10th_percentile":717.05,"90th_percentile":4144.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":432.53,"10th_percentile":271.02,"90th_percentile":2500.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"2014","median_amount":744.2,"10th_percentile":499.9,"90th_percentile":1099.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"169","median_amount":3315.73,"10th_percentile":580.0,"90th_percentile":4141.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"165","median_amount":789.43,"10th_percentile":512.17,"90th_percentile":1045.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"215","median_amount":1246.85,"10th_percentile":723.14,"90th_percentile":2825.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"200","median_amount":744.04,"10th_percentile":393.09,"90th_percentile":1788.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"89","median_amount":7145.47,"10th_percentile":2939.14,"90th_percentile":16537.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"248","median_amount":1249.38,"10th_percentile":636.9,"90th_percentile":2892.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2601.52,"10th_percentile":2601.52,"90th_percentile":2601.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"520","median_amount":1822.67,"10th_percentile":325.58,"90th_percentile":4679.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"451","median_amount":1898.32,"10th_percentile":239.77,"90th_percentile":4276.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"243","median_amount":1208.25,"10th_percentile":812.77,"90th_percentile":2707.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"12","median_amount":5669.48,"10th_percentile":3902.31,"90th_percentile":17858.02},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1156","median_amount":6860.27,"10th_percentile":3399.14,"90th_percentile":13548.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"536","median_amount":1909.0,"10th_percentile":1014.95,"90th_percentile":3467.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"76","median_amount":5161.99,"10th_percentile":1904.0,"90th_percentile":10451.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"179","median_amount":784.0,"10th_percentile":439.86,"90th_percentile":1504.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"171","median_amount":6271.52,"10th_percentile":3228.64,"90th_percentile":12205.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"62","median_amount":719.26,"10th_percentile":389.22,"90th_percentile":1295.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"889","median_amount":1148.2,"10th_percentile":569.29,"90th_percentile":2807.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":9239.7,"10th_percentile":9239.7,"90th_percentile":80339.88},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"214","median_amount":3905.63,"10th_percentile":2158.76,"90th_percentile":8548.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"225","median_amount":759.39,"10th_percentile":419.55,"90th_percentile":1924.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1373.28,"10th_percentile":903.78,"90th_percentile":3131.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"356","median_amount":1215.33,"10th_percentile":812.77,"90th_percentile":2613.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":2118.44,"10th_percentile":731.18,"90th_percentile":3490.81},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1428.49,"10th_percentile":823.03,"90th_percentile":2957.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":1118.49,"10th_percentile":937.19,"90th_percentile":2562.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":1352.26,"10th_percentile":996.47,"90th_percentile":2965.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"565","median_amount":697.74,"10th_percentile":372.26,"90th_percentile":1446.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"256","median_amount":3981.19,"10th_percentile":730.0,"90th_percentile":9606.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":569.28,"10th_percentile":265.2,"90th_percentile":3148.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1027","median_amount":1187.42,"10th_percentile":720.59,"90th_percentile":2773.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"58","median_amount":4067.4,"10th_percentile":635.83,"90th_percentile":9610.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"80","median_amount":1318.93,"10th_percentile":752.51,"90th_percentile":2768.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":2666.7,"10th_percentile":1461.39,"90th_percentile":2933.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":2242.72,"10th_percentile":491.18,"90th_percentile":3952.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":13092.64,"10th_percentile":13038.09,"90th_percentile":26588.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":2464.29,"10th_percentile":1469.65,"90th_percentile":3011.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":3175.03,"10th_percentile":707.11,"90th_percentile":4953.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":4575.09,"10th_percentile":3289.42,"90th_percentile":7469.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":2632.44,"10th_percentile":1555.29,"90th_percentile":2995.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":6661.07,"10th_percentile":6661.07,"90th_percentile":6661.07},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"54","median_amount":18051.01,"10th_percentile":7122.38,"90th_percentile":29416.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"33","median_amount":4004.23,"10th_percentile":2658.64,"90th_percentile":6122.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14749.96,"10th_percentile":14749.96,"90th_percentile":23290.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":758.45,"10th_percentile":415.68,"90th_percentile":2237.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"13","median_amount":8065.63,"10th_percentile":6279.39,"90th_percentile":12278.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":638.32,"10th_percentile":638.32,"90th_percentile":638.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"60","median_amount":2158.58,"10th_percentile":1292.25,"90th_percentile":2934.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4453.14,"10th_percentile":2677.35,"90th_percentile":8292.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":714.75,"10th_percentile":589.45,"90th_percentile":2269.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":2534.8,"10th_percentile":1359.6,"90th_percentile":2816.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1960.64,"10th_percentile":1960.64,"90th_percentile":1960.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":982.69,"10th_percentile":371.73,"90th_percentile":1695.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"13","median_amount":8642.68,"10th_percentile":3362.81,"90th_percentile":9895.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"51","median_amount":2696.07,"10th_percentile":1299.97,"90th_percentile":3039.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2845.54,"10th_percentile":2299.98,"90th_percentile":10990.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Trauma Response with Critical Care","code_information":[{"code":"5045","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":53496.3,"10th_percentile":53496.3,"90th_percentile":53496.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21857.61,"10th_percentile":21857.61,"90th_percentile":21857.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2810.64,"10th_percentile":2810.64,"90th_percentile":2810.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":443.72,"10th_percentile":443.72,"90th_percentile":443.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":732.3,"10th_percentile":732.3,"90th_percentile":732.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":2267.85,"10th_percentile":2267.85,"90th_percentile":2267.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":442.44,"10th_percentile":442.44,"90th_percentile":446.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":360.08,"10th_percentile":29.63,"90th_percentile":945.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1048.75,"10th_percentile":670.38,"90th_percentile":1452.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":546.43,"10th_percentile":522.8,"90th_percentile":717.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"41","median_amount":2058.77,"10th_percentile":379.78,"90th_percentile":3765.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":989.99,"10th_percentile":749.99,"90th_percentile":1474.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3286.11,"10th_percentile":3286.11,"90th_percentile":3286.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":574.63,"10th_percentile":565.23,"90th_percentile":574.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1740.45,"10th_percentile":1581.21,"90th_percentile":8445.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1483.02,"10th_percentile":1483.02,"90th_percentile":1483.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":316.47,"10th_percentile":194.86,"90th_percentile":451.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":985.56,"10th_percentile":979.95,"90th_percentile":1481.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":610.45,"10th_percentile":610.45,"90th_percentile":620.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":474.75,"10th_percentile":474.75,"90th_percentile":474.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":593.5,"10th_percentile":344.48,"90th_percentile":1152.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"11","median_amount":752.31,"10th_percentile":213.01,"90th_percentile":2889.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3969.53,"10th_percentile":3969.53,"90th_percentile":3969.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":272.23,"10th_percentile":272.23,"90th_percentile":272.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":1346.27,"10th_percentile":1346.27,"90th_percentile":4220.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1241.62,"10th_percentile":1241.62,"90th_percentile":1241.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1607.28,"10th_percentile":1566.86,"90th_percentile":1607.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":3382.27,"10th_percentile":963.16,"90th_percentile":3695.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":907.27,"10th_percentile":395.08,"90th_percentile":1389.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":886.89,"10th_percentile":451.78,"90th_percentile":1607.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1030.95,"10th_percentile":150.36,"90th_percentile":7576.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":799.1,"10th_percentile":799.1,"90th_percentile":878.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"42","median_amount":2635.78,"10th_percentile":759.97,"90th_percentile":4172.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"20","median_amount":812.14,"10th_percentile":363.36,"90th_percentile":1287.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4230.96,"10th_percentile":4230.96,"90th_percentile":4230.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1408.74,"10th_percentile":343.04,"90th_percentile":1461.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4448.72,"10th_percentile":1954.11,"90th_percentile":16222.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1538.62,"10th_percentile":1471.73,"90th_percentile":1635.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":860.9,"10th_percentile":391.82,"90th_percentile":975.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1455.16,"10th_percentile":1329.84,"90th_percentile":2350.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1578.05,"10th_percentile":1521.44,"90th_percentile":1818.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":836.41,"10th_percentile":828.49,"90th_percentile":3240.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"21","median_amount":1479.18,"10th_percentile":360.2,"90th_percentile":1541.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":2930.73,"10th_percentile":1717.35,"90th_percentile":25428.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":818.8,"10th_percentile":688.92,"90th_percentile":1004.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":2435.27,"10th_percentile":2435.27,"90th_percentile":2435.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":743.51,"10th_percentile":729.87,"90th_percentile":758.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":840.9,"10th_percentile":840.9,"90th_percentile":840.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":868.65,"10th_percentile":868.65,"90th_percentile":868.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":913.08,"10th_percentile":894.5,"90th_percentile":1528.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1054.18,"10th_percentile":1054.18,"90th_percentile":1519.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2427.82,"10th_percentile":1669.5,"90th_percentile":3448.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1671.47,"10th_percentile":1671.47,"90th_percentile":2023.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2349.88,"10th_percentile":2349.88,"90th_percentile":2349.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21084.59,"10th_percentile":21084.59,"90th_percentile":21084.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":766.62,"10th_percentile":316.62,"90th_percentile":1239.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2535.65,"10th_percentile":2535.65,"90th_percentile":2535.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2484.96,"10th_percentile":2484.96,"90th_percentile":2484.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":6857.4,"10th_percentile":6857.4,"90th_percentile":6857.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":596.2,"10th_percentile":582.21,"90th_percentile":1420.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":757.41,"10th_percentile":757.41,"90th_percentile":757.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1908.26,"10th_percentile":1906.22,"90th_percentile":2041.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2033.03,"10th_percentile":2033.03,"90th_percentile":2362.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2967.62,"10th_percentile":2967.62,"90th_percentile":3274.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4142.29,"10th_percentile":4142.29,"90th_percentile":4781.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1852.57,"10th_percentile":1764.31,"90th_percentile":1882.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11517.59,"10th_percentile":10508.33,"90th_percentile":18219.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3869.95,"10th_percentile":3267.11,"90th_percentile":4373.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12979.26,"10th_percentile":12979.26,"90th_percentile":12979.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":1812.51,"10th_percentile":619.32,"90th_percentile":1978.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5589.24,"10th_percentile":5589.24,"90th_percentile":5589.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2391.84,"10th_percentile":2391.84,"90th_percentile":2391.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3895.33,"10th_percentile":3895.33,"90th_percentile":3895.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1640.46,"10th_percentile":1640.46,"90th_percentile":1640.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1538.76,"10th_percentile":1538.76,"90th_percentile":1538.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":26597.06,"10th_percentile":26597.06,"90th_percentile":26692.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1887.77,"10th_percentile":1576.1,"90th_percentile":1938.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1991.1,"10th_percentile":1991.1,"90th_percentile":1991.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3401.15,"10th_percentile":3401.15,"90th_percentile":3401.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5495.68,"10th_percentile":5495.68,"90th_percentile":5495.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17979.45,"10th_percentile":17979.45,"90th_percentile":17979.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3739.13,"10th_percentile":3739.13,"90th_percentile":3739.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3659.85,"10th_percentile":3659.85,"90th_percentile":3659.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":658.99,"10th_percentile":296.36,"90th_percentile":671.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":216.97,"10th_percentile":216.97,"90th_percentile":1147.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"21","median_amount":2776.94,"10th_percentile":741.07,"90th_percentile":4626.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":546.08,"10th_percentile":351.07,"90th_percentile":690.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":891.65,"10th_percentile":585.85,"90th_percentile":1304.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"50","median_amount":1035.08,"10th_percentile":438.3,"90th_percentile":1567.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":650.95,"10th_percentile":355.95,"90th_percentile":1100.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":6674.52,"10th_percentile":6674.52,"90th_percentile":6674.52},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"234","median_amount":3366.96,"10th_percentile":1506.65,"90th_percentile":4882.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"153","median_amount":1040.4,"10th_percentile":740.32,"90th_percentile":1370.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":2807.26,"10th_percentile":622.42,"90th_percentile":3302.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":355.89,"10th_percentile":355.89,"90th_percentile":1383.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"24","median_amount":3873.0,"10th_percentile":3098.4,"90th_percentile":4787.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1343.35,"10th_percentile":1343.35,"90th_percentile":1343.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"77","median_amount":540.97,"10th_percentile":235.21,"90th_percentile":685.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":2071.61,"10th_percentile":1942.11,"90th_percentile":3064.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1181.49,"10th_percentile":158.48,"90th_percentile":1593.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":830.88,"10th_percentile":830.88,"90th_percentile":830.88},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":650.95,"10th_percentile":650.95,"90th_percentile":1178.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":720.63,"10th_percentile":720.63,"90th_percentile":720.63},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":546.08,"10th_percentile":546.08,"90th_percentile":546.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":612.41,"10th_percentile":612.41,"90th_percentile":1498.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"18","median_amount":194.63,"10th_percentile":154.08,"90th_percentile":1524.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"43","median_amount":2931.86,"10th_percentile":1227.31,"90th_percentile":4813.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"63","median_amount":535.87,"10th_percentile":276.36,"90th_percentile":671.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":2931.86,"10th_percentile":1499.46,"90th_percentile":4813.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":682.59,"10th_percentile":290.59,"90th_percentile":689.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"60","median_amount":1510.12,"10th_percentile":1140.7,"90th_percentile":1695.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":875.03,"10th_percentile":814.24,"90th_percentile":1663.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"24","median_amount":7875.78,"10th_percentile":3453.61,"90th_percentile":14743.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"52","median_amount":1572.14,"10th_percentile":1205.34,"90th_percentile":1668.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":2395.68,"10th_percentile":1902.24,"90th_percentile":3821.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"107","median_amount":1920.65,"10th_percentile":403.48,"90th_percentile":3420.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"60","median_amount":1499.01,"10th_percentile":1246.21,"90th_percentile":1686.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2822.77,"10th_percentile":2822.77,"90th_percentile":2822.77},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"513","median_amount":6016.96,"10th_percentile":3515.06,"90th_percentile":10477.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"322","median_amount":1962.41,"10th_percentile":1195.48,"90th_percentile":3292.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"51","median_amount":5499.98,"10th_percentile":2111.05,"90th_percentile":9664.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":717.15,"10th_percentile":712.59,"90th_percentile":2198.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"86","median_amount":6908.0,"10th_percentile":2903.58,"90th_percentile":15483.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1216.17,"10th_percentile":1216.17,"90th_percentile":1216.17},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2123.63,"10th_percentile":1170.69,"90th_percentile":2189.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"134","median_amount":1466.47,"10th_percentile":1024.39,"90th_percentile":1735.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":4735.38,"10th_percentile":4472.3,"90th_percentile":7900.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":804.36,"10th_percentile":799.44,"90th_percentile":2474.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"44","median_amount":1499.01,"10th_percentile":1499.01,"90th_percentile":1499.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":2393.95,"10th_percentile":2393.95,"90th_percentile":2393.95},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1578.29,"10th_percentile":1578.28,"90th_percentile":2221.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1410.27,"10th_percentile":1410.27,"90th_percentile":1770.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"20","median_amount":1312.28,"10th_percentile":753.01,"90th_percentile":3321.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"85","median_amount":4237.41,"10th_percentile":798.94,"90th_percentile":12946.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"107","median_amount":1502.74,"10th_percentile":1140.7,"90th_percentile":1807.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"17","median_amount":6593.33,"10th_percentile":798.94,"90th_percentile":9049.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1578.86,"10th_percentile":1257.49,"90th_percentile":2432.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":2678.51,"10th_percentile":2375.36,"90th_percentile":2896.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1731.67,"10th_percentile":1731.67,"90th_percentile":1731.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":15045.63,"10th_percentile":9505.74,"90th_percentile":28512.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":2784.07,"10th_percentile":2410.07,"90th_percentile":3032.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4766.24,"10th_percentile":3635.08,"90th_percentile":5518.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"25","median_amount":3185.67,"10th_percentile":821.43,"90th_percentile":5511.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":2647.91,"10th_percentile":2352.91,"90th_percentile":2800.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":11592.68,"10th_percentile":11592.68,"90th_percentile":11592.68},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"53","median_amount":11352.26,"10th_percentile":6438.82,"90th_percentile":16681.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"43","median_amount":2239.51,"10th_percentile":1821.01,"90th_percentile":4386.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12100.44,"10th_percentile":12100.44,"90th_percentile":12100.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1660.77,"10th_percentile":1660.77,"90th_percentile":1660.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"13","median_amount":7333.0,"10th_percentile":5345.05,"90th_percentile":22075.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2572.04,"10th_percentile":2572.04,"90th_percentile":2572.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"51","median_amount":2478.96,"10th_percentile":2249.13,"90th_percentile":2839.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8603.71,"10th_percentile":8090.94,"90th_percentile":8646.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":2647.91,"10th_percentile":2647.91,"90th_percentile":2647.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":656.61,"10th_percentile":656.61,"90th_percentile":1490.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"17","median_amount":12344.0,"10th_percentile":6675.3,"90th_percentile":18823.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":2465.94,"10th_percentile":2226.99,"90th_percentile":2708.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":18931.34,"10th_percentile":18931.34,"90th_percentile":18931.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2776.59,"10th_percentile":2731.12,"90th_percentile":2783.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6371.87,"10th_percentile":6310.62,"90th_percentile":6455.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2059.51,"10th_percentile":2059.51,"90th_percentile":2059.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6311.8,"10th_percentile":3675.11,"90th_percentile":6696.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6176.99,"10th_percentile":6176.99,"90th_percentile":6176.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"20","median_amount":6615.38,"10th_percentile":2958.73,"90th_percentile":11716.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3845.39,"10th_percentile":3493.83,"90th_percentile":6417.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"69","median_amount":23538.33,"10th_percentile":15327.34,"90th_percentile":41922.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"55","median_amount":5174.87,"10th_percentile":3560.96,"90th_percentile":10638.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"12","median_amount":31036.8,"10th_percentile":18153.62,"90th_percentile":37124.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1405.04,"10th_percentile":1405.04,"90th_percentile":1405.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23540.66,"10th_percentile":18965.0,"90th_percentile":33342.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3942.51,"10th_percentile":3942.51,"90th_percentile":3942.51},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2563.39,"10th_percentile":2563.39,"90th_percentile":2563.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":3902.14,"10th_percentile":3408.55,"90th_percentile":6184.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15830.41,"10th_percentile":11353.75,"90th_percentile":19501.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1570.31,"10th_percentile":1549.09,"90th_percentile":2820.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3754.43,"10th_percentile":3748.49,"90th_percentile":6367.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1511.28,"10th_percentile":1478.98,"90th_percentile":3022.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"17","median_amount":24820.47,"10th_percentile":16836.25,"90th_percentile":46284.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19959.58,"10th_percentile":19959.58,"90th_percentile":19959.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":3760.64,"10th_percentile":3383.3,"90th_percentile":6052.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":45852.09,"10th_percentile":45852.09,"90th_percentile":45852.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4006.12,"10th_percentile":4006.12,"90th_percentile":4006.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5092","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6429.45,"10th_percentile":6429.45,"90th_percentile":6429.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2394.63,"10th_percentile":929.9,"90th_percentile":2461.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7111.77,"10th_percentile":7111.77,"90th_percentile":7111.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9904.22,"10th_percentile":332.3,"90th_percentile":11626.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13343.08,"10th_percentile":10759.12,"90th_percentile":15771.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6425.83,"10th_percentile":6425.83,"90th_percentile":6425.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"45","median_amount":28479.76,"10th_percentile":21882.15,"90th_percentile":49289.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":4174.57,"10th_percentile":3773.2,"90th_percentile":19849.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22374.88,"10th_percentile":22374.88,"90th_percentile":24302.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2191.45,"10th_percentile":1578.1,"90th_percentile":2372.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32257.96,"10th_percentile":2744.96,"90th_percentile":39297.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":6456.76,"10th_percentile":6166.7,"90th_percentile":6858.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22247.43,"10th_percentile":22247.43,"90th_percentile":22247.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3301.88,"10th_percentile":2406.94,"90th_percentile":19623.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6488.31,"10th_percentile":6355.94,"90th_percentile":36387.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5974.08,"10th_percentile":5974.08,"90th_percentile":5974.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2294.37,"10th_percentile":880.61,"90th_percentile":2380.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":31735.49,"10th_percentile":24077.28,"90th_percentile":84492.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10910.79,"10th_percentile":10910.79,"90th_percentile":10910.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":52705.76,"10th_percentile":52705.76,"90th_percentile":52705.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6390.08,"10th_percentile":6390.08,"90th_percentile":6390.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5093","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35800.5,"10th_percentile":35800.5,"90th_percentile":35800.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19500.47,"10th_percentile":19500.47,"90th_percentile":19500.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19090.31,"10th_percentile":19090.31,"90th_percentile":19090.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5094","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33165.38,"10th_percentile":22939.51,"90th_percentile":76135.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":80983.21,"10th_percentile":80983.21,"90th_percentile":80983.21},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"17","median_amount":86590.85,"10th_percentile":60554.92,"90th_percentile":132281.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":28470.15,"10th_percentile":15683.98,"90th_percentile":63191.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63866.9,"10th_percentile":63866.9,"90th_percentile":143623.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57047.49,"10th_percentile":57047.49,"90th_percentile":57047.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17244.69,"10th_percentile":17244.69,"90th_percentile":17495.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":257.55,"10th_percentile":257.55,"90th_percentile":257.55},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56783.7,"10th_percentile":56783.7,"90th_percentile":56783.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16737.34,"10th_percentile":16737.34,"90th_percentile":16737.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6708.51,"10th_percentile":6708.51,"90th_percentile":6708.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":64903.26,"10th_percentile":2297.62,"90th_percentile":90042.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17104.35,"10th_percentile":17104.35,"90th_percentile":17104.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5625.22,"10th_percentile":5625.22,"90th_percentile":5625.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11578.69,"10th_percentile":11578.69,"90th_percentile":11578.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":345.44,"10th_percentile":345.44,"90th_percentile":1057.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1462.76,"10th_percentile":1462.76,"90th_percentile":1669.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":3986.29,"10th_percentile":3986.29,"90th_percentile":8992.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":886.58,"10th_percentile":886.58,"90th_percentile":886.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":776.08,"10th_percentile":634.12,"90th_percentile":10141.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6508.67,"10th_percentile":2766.29,"90th_percentile":7779.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":4405.12,"10th_percentile":1662.86,"90th_percentile":14980.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1229.49,"10th_percentile":1202.94,"90th_percentile":5780.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1586.21,"10th_percentile":1586.21,"90th_percentile":1586.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5455.11,"10th_percentile":5455.11,"90th_percentile":5455.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1030.23,"10th_percentile":1030.23,"90th_percentile":1613.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":914.29,"10th_percentile":914.29,"90th_percentile":914.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1659.02,"10th_percentile":1659.02,"90th_percentile":1659.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1677.88,"10th_percentile":1677.88,"90th_percentile":1677.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1447.87,"10th_percentile":1405.84,"90th_percentile":1447.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":10515.63,"10th_percentile":2002.12,"90th_percentile":20261.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.45,"10th_percentile":645.45,"90th_percentile":645.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2028.99,"10th_percentile":544.41,"90th_percentile":2076.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":6188.31,"10th_percentile":6188.31,"90th_percentile":8340.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1372.79,"10th_percentile":1372.79,"90th_percentile":1739.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":204.93,"10th_percentile":172.28,"90th_percentile":2834.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2856.73,"10th_percentile":2034.26,"90th_percentile":4180.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1577.59,"10th_percentile":1577.59,"90th_percentile":1917.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":11654.26,"10th_percentile":11654.26,"90th_percentile":11654.26},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"24","median_amount":9551.68,"10th_percentile":7338.08,"90th_percentile":11525.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":2325.28,"10th_percentile":1236.67,"90th_percentile":5470.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19868.09,"10th_percentile":19868.09,"90th_percentile":19868.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2162.29,"10th_percentile":2162.29,"90th_percentile":2254.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15957.58,"10th_percentile":15957.58,"90th_percentile":15957.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":2005.06,"10th_percentile":1602.38,"90th_percentile":2139.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3943.92,"10th_percentile":3943.92,"90th_percentile":3943.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1840.08,"10th_percentile":1840.08,"90th_percentile":1840.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1975.14,"10th_percentile":1975.14,"90th_percentile":1975.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":1699.6,"10th_percentile":608.95,"90th_percentile":2366.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":4361.88,"10th_percentile":3495.6,"90th_percentile":5811.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2641.03,"10th_percentile":2641.03,"90th_percentile":2641.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1878.87,"10th_percentile":1391.68,"90th_percentile":2072.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":10500.98,"10th_percentile":10500.98,"90th_percentile":10500.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3237.4,"10th_percentile":3168.88,"90th_percentile":3595.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2917.34,"10th_percentile":2917.34,"90th_percentile":2917.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":12129.61,"10th_percentile":11528.9,"90th_percentile":20442.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3073.68,"10th_percentile":3073.68,"90th_percentile":3278.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4891.36,"10th_percentile":4399.71,"90th_percentile":5597.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":5539.14,"10th_percentile":1760.98,"90th_percentile":7328.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":3134.37,"10th_percentile":2927.21,"90th_percentile":3173.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"70","median_amount":18949.6,"10th_percentile":13358.02,"90th_percentile":31726.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"31","median_amount":5359.51,"10th_percentile":3305.84,"90th_percentile":9036.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19384.97,"10th_percentile":14057.87,"90th_percentile":41635.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2541.38,"10th_percentile":2541.38,"90th_percentile":2541.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18982.34,"10th_percentile":13420.76,"90th_percentile":28253.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2549.65,"10th_percentile":2549.65,"90th_percentile":2549.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":3254.32,"10th_percentile":619.32,"90th_percentile":3987.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10716.65,"10th_percentile":10716.65,"90th_percentile":10716.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2420.32,"10th_percentile":2420.32,"90th_percentile":2420.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3423.8,"10th_percentile":3135.89,"90th_percentile":3451.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":201.6,"10th_percentile":201.6,"90th_percentile":201.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2327.56,"10th_percentile":2291.56,"90th_percentile":2678.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":15558.32,"10th_percentile":1287.96,"90th_percentile":30137.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2589.34,"10th_percentile":2589.34,"90th_percentile":2589.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2616.65,"10th_percentile":2548.86,"90th_percentile":3361.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":13152.76,"10th_percentile":13152.76,"90th_percentile":13152.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2707.75,"10th_percentile":2707.75,"90th_percentile":2707.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":7000.8,"10th_percentile":6744.04,"90th_percentile":7228.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2574.06,"10th_percentile":2574.06,"90th_percentile":5530.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":29492.41,"10th_percentile":25537.02,"90th_percentile":30462.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":7137.05,"10th_percentile":6991.48,"90th_percentile":7910.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":10441.7,"10th_percentile":6637.67,"90th_percentile":11704.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":11031.36,"10th_percentile":5861.92,"90th_percentile":22011.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":6806.52,"10th_percentile":6510.86,"90th_percentile":7051.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":26383.03,"10th_percentile":26383.03,"90th_percentile":26383.03},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"136","median_amount":32537.28,"10th_percentile":17296.0,"90th_percentile":50308.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"55","median_amount":9626.88,"10th_percentile":4044.5,"90th_percentile":14191.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30849.64,"10th_percentile":25019.73,"90th_percentile":47150.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2784.87,"10th_percentile":2784.87,"90th_percentile":2918.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"13","median_amount":30160.35,"10th_percentile":16050.3,"90th_percentile":35068.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3534.39,"10th_percentile":3534.39,"90th_percentile":3534.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":6903.26,"10th_percentile":5709.61,"90th_percentile":7901.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":23318.93,"10th_percentile":21684.37,"90th_percentile":24063.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3051.52,"10th_percentile":3051.29,"90th_percentile":4353.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7056.17,"10th_percentile":6923.74,"90th_percentile":7166.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5795.99,"10th_percentile":5795.99,"90th_percentile":5795.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2812.39,"10th_percentile":2327.56,"90th_percentile":2926.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"20","median_amount":26259.23,"10th_percentile":8915.95,"90th_percentile":43220.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":6045.24,"10th_percentile":5599.25,"90th_percentile":6980.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":5667.45,"10th_percentile":4474.15,"90th_percentile":32865.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6927.02,"10th_percentile":5919.22,"90th_percentile":7131.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":12935.4,"10th_percentile":12422.2,"90th_percentile":13312.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3430.6,"10th_percentile":3430.6,"90th_percentile":4359.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"15","median_amount":46918.14,"10th_percentile":39383.75,"90th_percentile":60551.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":13499.53,"10th_percentile":12293.5,"90th_percentile":13821.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":21229.98,"10th_percentile":14507.96,"90th_percentile":22866.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"50","median_amount":7184.06,"10th_percentile":4607.67,"90th_percentile":11685.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":12723.35,"10th_percentile":12327.83,"90th_percentile":12946.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"209","median_amount":19759.99,"10th_percentile":11193.7,"90th_percentile":34835.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"108","median_amount":23524.97,"10th_percentile":13693.49,"90th_percentile":28709.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"20","median_amount":19928.03,"10th_percentile":13058.36,"90th_percentile":37767.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2232.93,"10th_percentile":2232.93,"90th_percentile":2232.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"27","median_amount":29782.0,"10th_percentile":1342.55,"90th_percentile":33942.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1986.22,"10th_percentile":1986.22,"90th_percentile":1986.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"99","median_amount":12842.8,"10th_percentile":10711.32,"90th_percentile":13473.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":41739.1,"10th_percentile":34260.97,"90th_percentile":43604.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2114.86,"10th_percentile":2007.42,"90th_percentile":4068.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":12778.71,"10th_percentile":12305.66,"90th_percentile":12852.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":17764.75,"10th_percentile":17764.75,"90th_percentile":17764.75},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11823.06,"10th_percentile":11823.06,"90th_percentile":11823.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12088.84,"10th_percentile":12088.84,"90th_percentile":12088.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2127.58,"10th_percentile":1878.57,"90th_percentile":3878.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"37","median_amount":44997.71,"10th_percentile":39809.1,"90th_percentile":66284.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"80","median_amount":12681.77,"10th_percentile":10540.4,"90th_percentile":13203.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"11","median_amount":51159.38,"10th_percentile":44298.57,"90th_percentile":60161.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":13050.4,"10th_percentile":12990.01,"90th_percentile":13457.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":18099.17,"10th_percentile":18040.95,"90th_percentile":18472.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":84082.34,"10th_percentile":84082.34,"90th_percentile":84082.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18734.21,"10th_percentile":15055.82,"90th_percentile":19098.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31526.57,"10th_percentile":30969.15,"90th_percentile":32380.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13942.24,"10th_percentile":6727.17,"90th_percentile":15672.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":17614.93,"10th_percentile":17278.95,"90th_percentile":17810.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"51","median_amount":25966.63,"10th_percentile":15225.09,"90th_percentile":70511.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"31","median_amount":30164.31,"10th_percentile":20292.41,"90th_percentile":34461.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33821.08,"10th_percentile":33821.08,"90th_percentile":33821.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24464.41,"10th_percentile":1646.04,"90th_percentile":40510.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":404.28,"10th_percentile":404.28,"90th_percentile":404.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"30","median_amount":18281.34,"10th_percentile":17398.09,"90th_percentile":18587.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":60026.69,"10th_percentile":60026.69,"90th_percentile":60880.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2084.0,"10th_percentile":2084.0,"90th_percentile":2084.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17690.8,"10th_percentile":17576.6,"90th_percentile":19742.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2030.64,"10th_percentile":2030.64,"90th_percentile":2604.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":68263.93,"10th_percentile":50969.69,"90th_percentile":73903.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"39","median_amount":17627.88,"10th_percentile":15174.37,"90th_percentile":18364.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":79082.64,"10th_percentile":79082.64,"90th_percentile":79082.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Airway Endoscopy","code_information":[{"code":"5151","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":874.29,"10th_percentile":874.29,"90th_percentile":874.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1795.19,"10th_percentile":1465.19,"90th_percentile":2027.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1449.21,"10th_percentile":1449.21,"90th_percentile":1449.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":5271.23,"10th_percentile":5271.23,"90th_percentile":5271.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1944.92,"10th_percentile":1561.59,"90th_percentile":3842.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":178.51,"10th_percentile":178.51,"90th_percentile":178.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3211.9,"10th_percentile":3211.9,"90th_percentile":5014.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1741.81,"10th_percentile":1484.87,"90th_percentile":3275.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"26","median_amount":6237.68,"10th_percentile":3969.73,"90th_percentile":13790.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":3647.55,"10th_percentile":2455.17,"90th_percentile":6035.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13683.86,"10th_percentile":13683.86,"90th_percentile":13683.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6254.43,"10th_percentile":6254.43,"90th_percentile":8151.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":1835.68,"10th_percentile":1475.68,"90th_percentile":3764.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5260.35,"10th_percentile":5260.35,"90th_percentile":5260.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1783.68,"10th_percentile":1783.68,"90th_percentile":1783.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1761.61,"10th_percentile":1751.71,"90th_percentile":1844.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1680.07,"10th_percentile":1680.07,"90th_percentile":1680.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1781.43,"10th_percentile":1781.43,"90th_percentile":1804.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":8191.05,"10th_percentile":8191.05,"90th_percentile":13050.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1757.61,"10th_percentile":1434.41,"90th_percentile":1805.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":8301.36,"10th_percentile":8301.36,"90th_percentile":8301.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":3686.82,"10th_percentile":3539.94,"90th_percentile":6754.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2138.47,"10th_percentile":2138.47,"90th_percentile":2138.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":9295.49,"10th_percentile":9295.49,"90th_percentile":9295.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":3903.56,"10th_percentile":3759.29,"90th_percentile":7109.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8697.8,"10th_percentile":5444.41,"90th_percentile":12090.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7070.0,"10th_percentile":831.19,"90th_percentile":12488.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":6276.47,"10th_percentile":3585.15,"90th_percentile":6641.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"49","median_amount":7104.63,"10th_percentile":2275.27,"90th_percentile":15768.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":5523.5,"10th_percentile":1664.71,"90th_percentile":10499.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1442.25,"10th_percentile":1442.25,"90th_percentile":1489.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18362.63,"10th_percentile":18362.63,"90th_percentile":18362.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1583.69,"10th_percentile":1583.69,"90th_percentile":1583.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"37","median_amount":3788.71,"10th_percentile":3292.92,"90th_percentile":6907.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10410.03,"10th_percentile":10396.71,"90th_percentile":20159.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1885.77,"10th_percentile":1775.18,"90th_percentile":2652.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":6592.45,"10th_percentile":3581.21,"90th_percentile":6809.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":8325.92,"10th_percentile":8325.92,"90th_percentile":8325.92},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3061.42,"10th_percentile":3061.42,"90th_percentile":3061.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1623.82,"10th_percentile":1621.99,"90th_percentile":1950.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":21126.55,"10th_percentile":10422.51,"90th_percentile":34523.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":3681.96,"10th_percentile":3307.82,"90th_percentile":6605.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":11308.52,"10th_percentile":11308.52,"90th_percentile":11308.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6940.59,"10th_percentile":3783.01,"90th_percentile":6949.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6682.35,"10th_percentile":6682.35,"90th_percentile":6682.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2504.89,"10th_percentile":2504.89,"90th_percentile":2504.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7093.5,"10th_percentile":7093.5,"90th_percentile":7093.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13411.34,"10th_percentile":13411.34,"90th_percentile":13411.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6302.19,"10th_percentile":6302.19,"90th_percentile":6410.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15943.56,"10th_percentile":9233.11,"90th_percentile":20706.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9294.75,"10th_percentile":7813.18,"90th_percentile":9504.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11380.42,"10th_percentile":11380.42,"90th_percentile":11380.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30734.43,"10th_percentile":30734.43,"90th_percentile":30734.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6508.32,"10th_percentile":6417.74,"90th_percentile":6896.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6628.05,"10th_percentile":6614.21,"90th_percentile":6667.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2772.15,"10th_percentile":2772.15,"90th_percentile":3480.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":32230.65,"10th_percentile":32230.65,"90th_percentile":32230.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6776.08,"10th_percentile":6394.63,"90th_percentile":6808.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6972.99,"10th_percentile":6972.99,"90th_percentile":6972.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":912.9,"10th_percentile":912.9,"90th_percentile":912.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":20435.45,"10th_percentile":20435.45,"90th_percentile":20435.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2168.94,"10th_percentile":2168.94,"90th_percentile":2168.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1382.73,"10th_percentile":1348.08,"90th_percentile":1651.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":787.39,"10th_percentile":687.51,"90th_percentile":799.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":747.09,"10th_percentile":747.09,"90th_percentile":747.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":232.76,"10th_percentile":232.76,"90th_percentile":680.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":216.31,"10th_percentile":216.31,"90th_percentile":216.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ENT Procedures","code_information":[{"code":"5162","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2509.01,"10th_percentile":2509.01,"90th_percentile":2509.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6893.95,"10th_percentile":6893.95,"90th_percentile":6893.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1876.64,"10th_percentile":1876.64,"90th_percentile":1876.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1662.94,"10th_percentile":1662.94,"90th_percentile":1662.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1309.69,"10th_percentile":1309.69,"90th_percentile":1309.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1511.71,"10th_percentile":1511.71,"90th_percentile":1511.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2763.82,"10th_percentile":2763.82,"90th_percentile":2763.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1998.64,"10th_percentile":1998.64,"90th_percentile":1998.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":18435.46,"10th_percentile":18435.46,"90th_percentile":18435.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3449.28,"10th_percentile":3449.28,"90th_percentile":3449.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4257.79,"10th_percentile":4257.79,"90th_percentile":4257.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5986.25,"10th_percentile":5986.25,"90th_percentile":6431.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16303.79,"10th_percentile":10773.45,"90th_percentile":25137.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7341.4,"10th_percentile":2657.27,"90th_percentile":26675.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1441.23,"10th_percentile":1441.23,"90th_percentile":1441.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23194.42,"10th_percentile":23194.42,"90th_percentile":23194.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3316.27,"10th_percentile":3316.27,"90th_percentile":3316.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9160.37,"10th_percentile":9160.37,"90th_percentile":9160.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":346.26,"10th_percentile":346.26,"90th_percentile":346.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2158.86,"10th_percentile":2158.86,"90th_percentile":2158.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3304.72,"10th_percentile":3304.72,"90th_percentile":3304.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":13423.84,"10th_percentile":13423.84,"90th_percentile":13423.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5821.2,"10th_percentile":5536.78,"90th_percentile":5880.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1743.93,"10th_percentile":1743.93,"90th_percentile":1743.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":20641.18,"10th_percentile":20641.18,"90th_percentile":34289.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6026.53,"10th_percentile":5801.87,"90th_percentile":6233.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5675.81,"10th_percentile":5675.81,"90th_percentile":10377.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10928.81,"10th_percentile":9911.23,"90th_percentile":16194.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5702.91,"10th_percentile":5380.59,"90th_percentile":5838.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":27559.55,"10th_percentile":27559.55,"90th_percentile":27559.55},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"55","median_amount":28086.58,"10th_percentile":22709.16,"90th_percentile":37391.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"28","median_amount":8205.48,"10th_percentile":1580.25,"90th_percentile":10755.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24215.84,"10th_percentile":24215.84,"90th_percentile":43418.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":454.5,"10th_percentile":454.5,"90th_percentile":454.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27612.18,"10th_percentile":15654.21,"90th_percentile":32496.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":5884.87,"10th_percentile":4815.5,"90th_percentile":6007.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17702.95,"10th_percentile":17702.95,"90th_percentile":17702.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5365.78,"10th_percentile":5365.78,"90th_percentile":5365.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5700.53,"10th_percentile":5680.75,"90th_percentile":6169.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2697.04,"10th_percentile":2399.6,"90th_percentile":3102.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":21121.08,"10th_percentile":15513.1,"90th_percentile":31498.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5784.5,"10th_percentile":4738.76,"90th_percentile":5896.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":36426.03,"10th_percentile":20621.98,"90th_percentile":39145.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6072.98,"10th_percentile":6072.98,"90th_percentile":6072.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Cochlear Implant Procedure","code_information":[{"code":"5166","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30293.64,"10th_percentile":30293.64,"90th_percentile":30293.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28991.65,"10th_percentile":28991.65,"90th_percentile":28991.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":264977.59,"10th_percentile":264977.59,"90th_percentile":264977.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30447.26,"10th_percentile":30447.26,"90th_percentile":30447.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":582.99,"10th_percentile":563.48,"90th_percentile":589.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":490.98,"10th_percentile":490.98,"90th_percentile":490.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":6632.92,"10th_percentile":6632.92,"90th_percentile":6632.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":600.08,"10th_percentile":599.8,"90th_percentile":2555.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":602.25,"10th_percentile":602.25,"90th_percentile":602.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2140.28,"10th_percentile":1562.84,"90th_percentile":2731.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":572.0,"10th_percentile":552.0,"90th_percentile":572.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":3762.54,"10th_percentile":2654.37,"90th_percentile":5337.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"17","median_amount":1045.5,"10th_percentile":950.3,"90th_percentile":1613.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2351.25,"10th_percentile":2351.25,"90th_percentile":2351.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3089.0,"10th_percentile":3089.0,"90th_percentile":3089.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1455.77,"10th_percentile":1455.77,"90th_percentile":1455.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":596.79,"10th_percentile":237.81,"90th_percentile":2234.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":572.0,"10th_percentile":572.0,"90th_percentile":1614.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1529.24,"10th_percentile":1529.24,"90th_percentile":1529.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":5672.94,"10th_percentile":5672.94,"90th_percentile":5672.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":582.99,"10th_percentile":558.49,"90th_percentile":1809.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":256.8,"10th_percentile":207.8,"90th_percentile":602.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1633.81,"10th_percentile":1464.81,"90th_percentile":6795.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1597.24,"10th_percentile":1597.24,"90th_percentile":1597.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":6832.38,"10th_percentile":6832.38,"90th_percentile":6832.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1693.73,"10th_percentile":1693.73,"90th_percentile":1693.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2586.98,"10th_percentile":2586.98,"90th_percentile":2586.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2584.11,"10th_percentile":2531.28,"90th_percentile":2995.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1142.21,"10th_percentile":1142.21,"90th_percentile":1485.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":7699.83,"10th_percentile":7699.83,"90th_percentile":7699.83},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"38","median_amount":6967.66,"10th_percentile":5517.36,"90th_percentile":8517.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":2111.42,"10th_percentile":1855.38,"90th_percentile":2793.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5055.2,"10th_percentile":5055.2,"90th_percentile":5055.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1580.9,"10th_percentile":1580.9,"90th_percentile":1580.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8050.76,"10th_percentile":8050.76,"90th_percentile":8050.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1254.85,"10th_percentile":1254.85,"90th_percentile":1254.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":1171.97,"10th_percentile":1051.97,"90th_percentile":1503.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4287.92,"10th_percentile":4287.92,"90th_percentile":4711.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":492.92,"10th_percentile":492.92,"90th_percentile":495.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1437.21,"10th_percentile":1437.21,"90th_percentile":2489.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1352.13,"10th_percentile":1352.13,"90th_percentile":1352.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":670.8,"10th_percentile":473.92,"90th_percentile":1523.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":13515.36,"10th_percentile":13515.36,"90th_percentile":15315.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1341.48,"10th_percentile":1077.71,"90th_percentile":1803.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":2974.42,"10th_percentile":2788.52,"90th_percentile":3326.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1428.13,"10th_percentile":1405.89,"90th_percentile":2818.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":21851.29,"10th_percentile":20212.01,"90th_percentile":29137.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":2911.02,"10th_percentile":2693.0,"90th_percentile":3393.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5241.6,"10th_percentile":633.97,"90th_percentile":5580.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":4512.19,"10th_percentile":4285.46,"90th_percentile":8625.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":2912.0,"10th_percentile":2617.0,"90th_percentile":3091.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":18799.48,"10th_percentile":18799.48,"90th_percentile":18799.48},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"89","median_amount":19054.42,"10th_percentile":15230.19,"90th_percentile":24506.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"53","median_amount":2370.63,"10th_percentile":1860.02,"90th_percentile":5592.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18333.6,"10th_percentile":18078.59,"90th_percentile":26492.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1249.79,"10th_percentile":1249.79,"90th_percentile":2680.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19333.39,"10th_percentile":16019.48,"90th_percentile":29198.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1439.92,"10th_percentile":1263.62,"90th_percentile":1518.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":2774.47,"10th_percentile":2555.45,"90th_percentile":3204.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9199.01,"10th_percentile":9199.01,"90th_percentile":12915.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1535.67,"10th_percentile":1364.37,"90th_percentile":8978.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":3076.18,"10th_percentile":2912.0,"90th_percentile":3264.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3785.62,"10th_percentile":3785.62,"90th_percentile":3785.62},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2739.61,"10th_percentile":2739.61,"90th_percentile":2739.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1506.02,"10th_percentile":1460.4,"90th_percentile":2559.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"22","median_amount":22226.98,"10th_percentile":12608.56,"90th_percentile":35612.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"64","median_amount":2967.92,"10th_percentile":2485.55,"90th_percentile":3381.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":22060.96,"10th_percentile":22060.96,"90th_percentile":43068.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":2973.94,"10th_percentile":2605.62,"90th_percentile":3453.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5262.86,"10th_percentile":5097.28,"90th_percentile":5626.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2710.37,"10th_percentile":2710.37,"90th_percentile":2710.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5873.1,"10th_percentile":5873.1,"90th_percentile":9055.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9414.64,"10th_percentile":9414.64,"90th_percentile":9414.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11376.62,"10th_percentile":11376.62,"90th_percentile":11376.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4984.0,"10th_percentile":4984.0,"90th_percentile":4984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27645.34,"10th_percentile":26304.74,"90th_percentile":43564.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8449.83,"10th_percentile":7452.48,"90th_percentile":8545.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5195.3,"10th_percentile":5155.15,"90th_percentile":5880.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15251.89,"10th_percentile":15251.89,"90th_percentile":15251.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1727.34,"10th_percentile":1727.34,"90th_percentile":1727.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5351.37,"10th_percentile":5351.37,"90th_percentile":5351.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4195.45,"10th_percentile":4195.45,"90th_percentile":4195.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1655.67,"10th_percentile":1655.67,"90th_percentile":1683.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":28056.01,"10th_percentile":28056.01,"90th_percentile":28056.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5024.9,"10th_percentile":4351.4,"90th_percentile":5430.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":28184.11,"10th_percentile":28184.11,"90th_percentile":28184.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5607.29,"10th_percentile":5607.29,"90th_percentile":5607.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":3039.4,"10th_percentile":2709.5,"90th_percentile":3210.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4909.89,"10th_percentile":4909.89,"90th_percentile":4933.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"19","median_amount":20754.72,"10th_percentile":17299.36,"90th_percentile":28122.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":3127.86,"10th_percentile":2947.9,"90th_percentile":3141.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":3481.64,"10th_percentile":276.92,"90th_percentile":5380.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"78","median_amount":8934.0,"10th_percentile":1446.89,"90th_percentile":10608.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"86","median_amount":2975.76,"10th_percentile":2694.15,"90th_percentile":3029.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"291","median_amount":24568.04,"10th_percentile":20101.67,"90th_percentile":29594.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"139","median_amount":6963.98,"10th_percentile":6148.58,"90th_percentile":8376.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":19929.14,"10th_percentile":18903.39,"90th_percentile":25468.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4720.46,"10th_percentile":4484.83,"90th_percentile":5681.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"32","median_amount":20360.0,"10th_percentile":17378.0,"90th_percentile":21048.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4503.41,"10th_percentile":4482.13,"90th_percentile":4535.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"169","median_amount":3100.22,"10th_percentile":2650.22,"90th_percentile":3155.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":9400.43,"10th_percentile":8605.63,"90th_percentile":10572.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4884.23,"10th_percentile":4853.31,"90th_percentile":5317.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3513.78,"10th_percentile":3513.78,"90th_percentile":3513.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"47","median_amount":2975.76,"10th_percentile":2975.76,"90th_percentile":3174.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3917.48,"10th_percentile":3570.91,"90th_percentile":35335.52},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3455.21,"10th_percentile":3455.21,"90th_percentile":3455.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":4744.86,"10th_percentile":4705.69,"90th_percentile":5388.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"41","median_amount":22493.77,"10th_percentile":4485.35,"90th_percentile":29645.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7439.4,"10th_percentile":7439.4,"90th_percentile":7439.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"149","median_amount":3040.8,"10th_percentile":2645.8,"90th_percentile":3163.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":19104.1,"10th_percentile":3332.84,"90th_percentile":25375.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3056.18,"10th_percentile":2803.04,"90th_percentile":5445.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5057.72,"10th_percentile":5057.72,"90th_percentile":5057.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1550.87,"10th_percentile":1550.87,"90th_percentile":1550.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":21142.01,"10th_percentile":21142.01,"90th_percentile":21142.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5740.1,"10th_percentile":5740.1,"90th_percentile":5740.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3470.02,"10th_percentile":3470.02,"90th_percentile":3470.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5288.32,"10th_percentile":5288.32,"90th_percentile":5593.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":57109.51,"10th_percentile":56492.35,"90th_percentile":81509.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2025.91,"10th_percentile":2025.91,"90th_percentile":2025.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5479.6,"10th_percentile":5479.6,"90th_percentile":5886.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5532.7,"10th_percentile":5532.7,"90th_percentile":5532.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":4989.12,"10th_percentile":4269.95,"90th_percentile":10960.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10642.93,"10th_percentile":10238.26,"90th_percentile":22838.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6518.13,"10th_percentile":6518.13,"90th_percentile":6518.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":64825.94,"10th_percentile":47091.32,"90th_percentile":65650.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10917.76,"10th_percentile":8911.78,"90th_percentile":16755.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17094.21,"10th_percentile":11502.2,"90th_percentile":29204.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"22","median_amount":9166.8,"10th_percentile":1078.88,"90th_percentile":35207.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":10448.47,"10th_percentile":10197.07,"90th_percentile":10856.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"69","median_amount":91197.39,"10th_percentile":55517.68,"90th_percentile":124772.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"33","median_amount":29704.87,"10th_percentile":17690.27,"90th_percentile":46008.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":85591.12,"10th_percentile":85591.12,"90th_percentile":91401.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57997.0,"10th_percentile":56049.89,"90th_percentile":58466.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":10619.95,"10th_percentile":10047.14,"90th_percentile":11267.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":20.0,"10th_percentile":20.0,"90th_percentile":20.0},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10221.12,"10th_percentile":10221.12,"90th_percentile":36046.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1703.25,"10th_percentile":1384.21,"90th_percentile":35583.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":10493.28,"10th_percentile":10492.07,"90th_percentile":12962.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11046.89,"10th_percentile":11046.89,"90th_percentile":11046.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5136.76,"10th_percentile":5136.76,"90th_percentile":5136.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":62957.23,"10th_percentile":49966.77,"90th_percentile":120948.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"41","median_amount":10715.18,"10th_percentile":8637.08,"90th_percentile":13472.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":17440.59,"10th_percentile":17440.59,"90th_percentile":84126.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11001.98,"10th_percentile":10732.48,"90th_percentile":11001.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16940.08,"10th_percentile":16940.08,"90th_percentile":16940.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":154.83,"10th_percentile":154.83,"90th_percentile":154.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17647.79,"10th_percentile":17647.79,"90th_percentile":17647.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28272.19,"10th_percentile":28272.19,"90th_percentile":28272.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31279.39,"10th_percentile":22985.99,"90th_percentile":35375.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16613.2,"10th_percentile":16318.2,"90th_percentile":16938.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":90717.6,"10th_percentile":80576.62,"90th_percentile":91148.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28934.23,"10th_percentile":26450.72,"90th_percentile":34732.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":86388.48,"10th_percentile":86388.48,"90th_percentile":86388.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58466.0,"10th_percentile":58466.0,"90th_percentile":58466.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":17257.79,"10th_percentile":16816.79,"90th_percentile":17620.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56201.88,"10th_percentile":56201.88,"90th_percentile":56201.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16613.2,"10th_percentile":16613.2,"90th_percentile":16613.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":13633.21,"10th_percentile":13633.21,"90th_percentile":13633.21},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2319.18,"10th_percentile":2319.18,"90th_percentile":2319.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":69884.66,"10th_percentile":68867.51,"90th_percentile":72704.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16545.08,"10th_percentile":14209.02,"90th_percentile":17322.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":74278.2,"10th_percentile":74278.2,"90th_percentile":74278.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Electrophysiologic Procedures","code_information":[{"code":"5212","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13079.73,"10th_percentile":13079.73,"90th_percentile":13079.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7307.16,"10th_percentile":7307.16,"90th_percentile":7307.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":33338.82,"10th_percentile":33338.82,"90th_percentile":33338.82},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34361.74,"10th_percentile":34361.74,"90th_percentile":34452.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23662.46,"10th_percentile":23662.46,"90th_percentile":23662.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7190.39,"10th_percentile":7190.39,"90th_percentile":7190.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":60425.66,"10th_percentile":60425.66,"90th_percentile":60425.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7482.61,"10th_percentile":7482.61,"90th_percentile":7482.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Electrophysiologic Procedures","code_information":[{"code":"5213","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":23462.13,"10th_percentile":23049.91,"90th_percentile":23539.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":60537.97,"10th_percentile":60537.97,"90th_percentile":60537.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":24131.72,"10th_percentile":19566.48,"90th_percentile":24482.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":41352.68,"10th_percentile":39599.29,"90th_percentile":41435.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":23480.83,"10th_percentile":13981.45,"90th_percentile":24842.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":23042.93,"10th_percentile":22800.17,"90th_percentile":23074.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"90","median_amount":68176.99,"10th_percentile":64642.74,"90th_percentile":74154.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"41","median_amount":20931.97,"10th_percentile":18939.2,"90th_percentile":22160.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63934.43,"10th_percentile":61970.91,"90th_percentile":66077.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2276.3,"10th_percentile":2276.3,"90th_percentile":2276.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50530.84,"10th_percentile":13779.56,"90th_percentile":70683.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":23783.57,"10th_percentile":19197.17,"90th_percentile":24030.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":77997.57,"10th_percentile":77410.42,"90th_percentile":80173.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2617.41,"10th_percentile":2617.41,"90th_percentile":2617.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":23051.39,"10th_percentile":22999.43,"90th_percentile":23106.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":75.0,"10th_percentile":75.0,"90th_percentile":75.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7512.59,"10th_percentile":7512.59,"90th_percentile":7512.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"17","median_amount":120754.38,"10th_percentile":80802.22,"90th_percentile":135985.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":23463.43,"10th_percentile":18995.39,"90th_percentile":23533.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":120981.31,"10th_percentile":56991.98,"90th_percentile":133303.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19326.95,"10th_percentile":19326.95,"90th_percentile":19326.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Pacemaker and Similar Procedures","code_information":[{"code":"5221","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21648.64,"10th_percentile":21648.64,"90th_percentile":21648.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4569.9,"10th_percentile":4569.9,"90th_percentile":4569.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pacemaker and Similar Procedures","code_information":[{"code":"5222","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7810.38,"10th_percentile":7810.38,"90th_percentile":7810.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":48922.06,"10th_percentile":44284.72,"90th_percentile":67874.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6423.11,"10th_percentile":6423.11,"90th_percentile":6423.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13782.19,"10th_percentile":13782.19,"90th_percentile":13782.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12480.06,"10th_percentile":4956.42,"90th_percentile":13382.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7656.77,"10th_percentile":7656.77,"90th_percentile":7656.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"12","median_amount":47922.21,"10th_percentile":46511.41,"90th_percentile":48477.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13668.66,"10th_percentile":11545.4,"90th_percentile":21804.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":7785.56,"10th_percentile":6363.1,"90th_percentile":7965.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7870.39,"10th_percentile":7870.39,"90th_percentile":7870.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6130.14,"10th_percentile":6130.14,"90th_percentile":6157.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":42827.14,"10th_percentile":42827.14,"90th_percentile":46362.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":7416.68,"10th_percentile":6198.01,"90th_percentile":8292.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8550.6,"10th_percentile":8550.6,"90th_percentile":8550.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Pacemaker and Similar Procedures","code_information":[{"code":"5223","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":10004.31,"10th_percentile":9649.79,"90th_percentile":10205.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10470.21,"10th_percentile":10417.32,"90th_percentile":10505.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32260.88,"10th_percentile":2019.82,"90th_percentile":33073.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":9826.69,"10th_percentile":9652.27,"90th_percentile":10185.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":68183.83,"10th_percentile":51077.04,"90th_percentile":68954.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27869.59,"10th_percentile":22682.78,"90th_percentile":29184.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59640.53,"10th_percentile":59640.53,"90th_percentile":59640.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":10272.04,"10th_percentile":9895.55,"90th_percentile":11654.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32063.49,"10th_percentile":32063.49,"90th_percentile":32063.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2819.87,"10th_percentile":2819.87,"90th_percentile":2819.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10033.75,"10th_percentile":9917.24,"90th_percentile":10547.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9309.77,"10th_percentile":9309.77,"90th_percentile":9309.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":100558.12,"10th_percentile":100558.12,"90th_percentile":100558.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":9899.17,"10th_percentile":8000.97,"90th_percentile":10157.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10363.13,"10th_percentile":10363.13,"90th_percentile":10363.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Pacemaker and Similar Procedures","code_information":[{"code":"5224","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18217.87,"10th_percentile":18217.87,"90th_percentile":18217.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18736.36,"10th_percentile":18736.36,"90th_percentile":18736.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21363.18,"10th_percentile":21363.18,"90th_percentile":21363.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17849.98,"10th_percentile":17849.98,"90th_percentile":17849.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17754.33,"10th_percentile":622.21,"90th_percentile":18317.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18109.77,"10th_percentile":18109.77,"90th_percentile":18109.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 ICD and Similar Procedures","code_information":[{"code":"5231","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":358.88,"10th_percentile":358.88,"90th_percentile":358.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":72786.46,"10th_percentile":72786.46,"90th_percentile":72786.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":149150.65,"10th_percentile":149150.65,"90th_percentile":149150.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21364.34,"10th_percentile":21364.34,"90th_percentile":21399.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20868.38,"10th_percentile":17330.8,"90th_percentile":21389.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 ICD and Similar Procedures","code_information":[{"code":"5232","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30175.0,"10th_percentile":29989.49,"90th_percentile":30516.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":343.21,"10th_percentile":343.21,"90th_percentile":343.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31376.72,"10th_percentile":31376.72,"90th_percentile":31488.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":53752.91,"10th_percentile":53752.91,"90th_percentile":53752.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":98226.2,"10th_percentile":91822.09,"90th_percentile":98532.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29907.99,"10th_percentile":29822.93,"90th_percentile":30008.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":201701.28,"10th_percentile":146386.95,"90th_percentile":255752.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":112126.59,"10th_percentile":111477.68,"90th_percentile":115362.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":184461.71,"10th_percentile":184461.71,"90th_percentile":184461.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22329.04,"10th_percentile":22329.04,"90th_percentile":22329.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31055.46,"10th_percentile":30668.94,"90th_percentile":31245.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":104494.78,"10th_percentile":104494.78,"90th_percentile":104494.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4496.58,"10th_percentile":4496.58,"90th_percentile":4496.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29985.15,"10th_percentile":29917.89,"90th_percentile":288263.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":187439.23,"10th_percentile":171907.18,"90th_percentile":202194.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":30104.34,"10th_percentile":24657.23,"90th_percentile":30563.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31386.2,"10th_percentile":31386.2,"90th_percentile":31386.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":936.93,"10th_percentile":597.74,"90th_percentile":5237.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":638.95,"10th_percentile":409.39,"90th_percentile":809.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":14292.31,"10th_percentile":7624.76,"90th_percentile":34526.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":864.15,"10th_percentile":614.97,"90th_percentile":2542.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8192.87,"10th_percentile":1128.61,"90th_percentile":9963.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"40","median_amount":2155.27,"10th_percentile":1443.84,"90th_percentile":9453.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"54","median_amount":718.47,"10th_percentile":404.47,"90th_percentile":1536.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":7502.1,"10th_percentile":7502.1,"90th_percentile":7502.1},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"73","median_amount":4569.93,"10th_percentile":2237.76,"90th_percentile":8532.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"55","median_amount":1552.96,"10th_percentile":1070.52,"90th_percentile":4652.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4680.15,"10th_percentile":2956.69,"90th_percentile":5898.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":207.65,"10th_percentile":207.65,"90th_percentile":207.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12268.4,"10th_percentile":6601.9,"90th_percentile":30891.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":490.23,"10th_percentile":490.23,"90th_percentile":490.23},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1903.12,"10th_percentile":1903.12,"90th_percentile":1903.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"71","median_amount":749.29,"10th_percentile":474.21,"90th_percentile":2743.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8598.2,"10th_percentile":8598.2,"90th_percentile":8598.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":618.34,"10th_percentile":618.34,"90th_percentile":1310.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1485.55,"10th_percentile":915.78,"90th_percentile":2812.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":1158.65,"10th_percentile":586.47,"90th_percentile":2863.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1444.87,"10th_percentile":1444.87,"90th_percentile":1444.87},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":545.0,"10th_percentile":417.84,"90th_percentile":1090.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"19","median_amount":1920.54,"10th_percentile":939.61,"90th_percentile":12334.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":910.0,"10th_percentile":910.0,"90th_percentile":910.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"101","median_amount":927.7,"10th_percentile":482.8,"90th_percentile":2763.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":1010.22,"10th_percentile":614.97,"90th_percentile":3904.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"62","median_amount":890.57,"10th_percentile":565.57,"90th_percentile":1585.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"22","median_amount":2238.89,"10th_percentile":892.89,"90th_percentile":2433.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"13","median_amount":11789.81,"10th_percentile":2724.84,"90th_percentile":14701.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":1200.07,"10th_percentile":909.57,"90th_percentile":1949.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"72","median_amount":1561.34,"10th_percentile":1361.34,"90th_percentile":2238.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"125","median_amount":1506.2,"10th_percentile":1172.97,"90th_percentile":2575.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"127","median_amount":867.41,"10th_percentile":572.41,"90th_percentile":1425.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"246","median_amount":5680.35,"10th_percentile":2529.0,"90th_percentile":13328.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"72","median_amount":1519.4,"10th_percentile":930.5,"90th_percentile":3031.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":4702.74,"10th_percentile":2529.0,"90th_percentile":10207.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":2154.16,"10th_percentile":748.02,"90th_percentile":2569.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"20","median_amount":6525.07,"10th_percentile":3293.0,"90th_percentile":16219.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"14","median_amount":2080.78,"10th_percentile":2035.36,"90th_percentile":2394.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"130","median_amount":1032.86,"10th_percentile":460.37,"90th_percentile":2704.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":2740.15,"10th_percentile":2732.18,"90th_percentile":7973.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"19","median_amount":2376.15,"10th_percentile":1508.69,"90th_percentile":3951.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1483.96,"10th_percentile":867.41,"90th_percentile":2819.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":867.41,"10th_percentile":867.41,"90th_percentile":17488.69},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1049.77,"10th_percentile":1049.77,"90th_percentile":1049.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1166.64,"10th_percentile":975.72,"90th_percentile":1669.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"46","median_amount":2293.8,"10th_percentile":1503.92,"90th_percentile":3344.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"31","median_amount":5962.03,"10th_percentile":645.92,"90th_percentile":25712.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3694.27,"10th_percentile":3694.27,"90th_percentile":3694.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"195","median_amount":984.35,"10th_percentile":624.51,"90th_percentile":2186.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":16700.88,"10th_percentile":16700.88,"90th_percentile":46841.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":1036.89,"10th_percentile":566.57,"90th_percentile":2717.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1930.38,"10th_percentile":1645.12,"90th_percentile":1987.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1322.56,"10th_percentile":1322.56,"90th_percentile":1399.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":7036.93,"10th_percentile":1642.96,"90th_percentile":7529.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":1991.03,"10th_percentile":1676.06,"90th_percentile":3324.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2931.25,"10th_percentile":2514.71,"90th_percentile":3380.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"21","median_amount":1300.0,"10th_percentile":1030.77,"90th_percentile":3372.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1903.4,"10th_percentile":1662.44,"90th_percentile":1965.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"60","median_amount":6069.92,"10th_percentile":4879.9,"90th_percentile":12304.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"46","median_amount":1761.17,"10th_percentile":1158.57,"90th_percentile":2859.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5737.2,"10th_percentile":5304.36,"90th_percentile":16216.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2120.75,"10th_percentile":2120.75,"90th_percentile":2120.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5464.04,"10th_percentile":646.08,"90th_percentile":8531.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1770.31,"10th_percentile":1770.31,"90th_percentile":3405.93},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"51","median_amount":1973.31,"10th_percentile":1530.31,"90th_percentile":2181.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5725.19,"10th_percentile":5590.19,"90th_percentile":6358.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2455.42,"10th_percentile":2341.5,"90th_percentile":3757.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1796.34,"10th_percentile":1796.34,"90th_percentile":1796.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":1929.12,"10th_percentile":1755.06,"90th_percentile":2069.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5473.85,"10th_percentile":5473.85,"90th_percentile":5473.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2366.99,"10th_percentile":2366.99,"90th_percentile":2366.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2309.56,"10th_percentile":2306.4,"90th_percentile":2350.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":7200.12,"10th_percentile":3576.42,"90th_percentile":10649.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"59","median_amount":1866.16,"10th_percentile":1564.16,"90th_percentile":2097.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":5431.1,"10th_percentile":5431.1,"90th_percentile":5431.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1985.55,"10th_percentile":1855.16,"90th_percentile":2018.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3744.09,"10th_percentile":3518.41,"90th_percentile":3791.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3520.91,"10th_percentile":3520.91,"90th_percentile":3520.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3981.59,"10th_percentile":3644.88,"90th_percentile":3997.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7155.32,"10th_percentile":7155.32,"90th_percentile":7155.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3415.56,"10th_percentile":3415.56,"90th_percentile":3415.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14177.03,"10th_percentile":9545.48,"90th_percentile":17618.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3111.39,"10th_percentile":3111.39,"90th_percentile":3111.39},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2351.01,"10th_percentile":2351.01,"90th_percentile":2351.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3898.27,"10th_percentile":3596.41,"90th_percentile":3898.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":20000.37,"10th_percentile":10273.39,"90th_percentile":21954.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3595.91,"10th_percentile":3467.19,"90th_percentile":3932.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3315.24,"10th_percentile":3315.24,"90th_percentile":3315.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3933.12,"10th_percentile":3933.12,"90th_percentile":3933.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1001.64,"10th_percentile":974.9,"90th_percentile":2795.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1546.63,"10th_percentile":1546.63,"90th_percentile":1656.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":5804.81,"10th_percentile":4103.52,"90th_percentile":11211.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1068.06,"10th_percentile":1055.63,"90th_percentile":1622.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1656.76,"10th_percentile":1263.34,"90th_percentile":15470.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":1172.13,"10th_percentile":985.5,"90th_percentile":3343.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":948.32,"10th_percentile":930.52,"90th_percentile":964.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"73","median_amount":5569.74,"10th_percentile":2865.51,"90th_percentile":10719.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"36","median_amount":1282.18,"10th_percentile":1152.48,"90th_percentile":2458.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5527.49,"10th_percentile":5073.04,"90th_percentile":5731.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"13","median_amount":6887.29,"10th_percentile":3322.45,"90th_percentile":8845.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1389.45,"10th_percentile":1389.45,"90th_percentile":1389.45},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":135.11,"10th_percentile":135.11,"90th_percentile":135.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":1024.39,"10th_percentile":982.05,"90th_percentile":1462.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3055.99,"10th_percentile":3049.47,"90th_percentile":3417.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1644.29,"10th_percentile":1545.7,"90th_percentile":2526.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1379.97,"10th_percentile":944.38,"90th_percentile":3089.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1180.9,"10th_percentile":1180.9,"90th_percentile":1180.9},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":935.07,"10th_percentile":935.07,"90th_percentile":935.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1497.29,"10th_percentile":1445.56,"90th_percentile":2467.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":5512.25,"10th_percentile":3873.12,"90th_percentile":28104.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":985.18,"10th_percentile":971.63,"90th_percentile":2576.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3672.52,"10th_percentile":3672.52,"90th_percentile":5380.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1015.94,"10th_percentile":1015.94,"90th_percentile":1045.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":1274.31,"10th_percentile":1220.83,"90th_percentile":2441.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1560.33,"10th_percentile":1560.33,"90th_percentile":2191.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"13","median_amount":6518.52,"10th_percentile":5089.92,"90th_percentile":9977.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":1835.44,"10th_percentile":1327.44,"90th_percentile":3151.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":2129.71,"10th_percentile":1147.93,"90th_percentile":4316.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"37","median_amount":1318.48,"10th_percentile":732.98,"90th_percentile":4245.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":1221.4,"10th_percentile":1189.76,"90th_percentile":2042.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"116","median_amount":6719.74,"10th_percentile":5355.83,"90th_percentile":13250.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"67","median_amount":1580.49,"10th_percentile":1276.94,"90th_percentile":3005.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":6263.88,"10th_percentile":5937.97,"90th_percentile":8721.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":738.48,"10th_percentile":738.48,"90th_percentile":738.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"19","median_amount":8484.14,"10th_percentile":6341.36,"90th_percentile":24378.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1333.2,"10th_percentile":1333.2,"90th_percentile":1333.2},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1425.23,"10th_percentile":1425.23,"90th_percentile":1425.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"75","median_amount":1281.34,"10th_percentile":1260.18,"90th_percentile":2548.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":4003.86,"10th_percentile":3913.78,"90th_percentile":6536.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2446.62,"10th_percentile":2432.45,"90th_percentile":6173.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":2201.38,"10th_percentile":1207.56,"90th_percentile":3798.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":9312.7,"10th_percentile":9312.7,"90th_percentile":9312.7},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2528.27,"10th_percentile":2528.27,"90th_percentile":2528.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1152.86,"10th_percentile":1152.86,"90th_percentile":1152.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2306.4,"10th_percentile":2246.08,"90th_percentile":2526.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"12","median_amount":6271.86,"10th_percentile":4790.27,"90th_percentile":8765.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"94","median_amount":1787.02,"10th_percentile":1229.07,"90th_percentile":3578.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":7911.59,"10th_percentile":5558.71,"90th_percentile":10193.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1833.25,"10th_percentile":1258.44,"90th_percentile":1867.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2810.14,"10th_percentile":2810.14,"90th_percentile":2810.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2425.18,"10th_percentile":2425.18,"90th_percentile":2425.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":16290.02,"10th_percentile":13886.21,"90th_percentile":16893.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3350.95,"10th_percentile":3073.11,"90th_percentile":3404.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":5607.17,"10th_percentile":2353.24,"90th_percentile":13356.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3097.46,"10th_percentile":2748.84,"90th_percentile":3109.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":24142.91,"10th_percentile":24142.91,"90th_percentile":24142.91},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"46","median_amount":16687.31,"10th_percentile":10208.52,"90th_percentile":26514.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"22","median_amount":5522.31,"10th_percentile":3946.59,"90th_percentile":11296.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14051.49,"10th_percentile":14051.49,"90th_percentile":21750.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19321.1,"10th_percentile":8445.18,"90th_percentile":33418.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3269.09,"10th_percentile":2909.54,"90th_percentile":3519.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":19593.48,"10th_percentile":19593.48,"90th_percentile":19593.48},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10510.9,"10th_percentile":8873.97,"90th_percentile":10563.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7828.53,"10th_percentile":2415.82,"90th_percentile":10062.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1610.62,"10th_percentile":1610.62,"90th_percentile":1610.62},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2327.56,"10th_percentile":1502.72,"90th_percentile":2348.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":14837.17,"10th_percentile":13526.31,"90th_percentile":21421.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2831.02,"10th_percentile":2784.45,"90th_percentile":3315.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":17321.02,"10th_percentile":17321.02,"90th_percentile":17321.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3299.16,"10th_percentile":3299.16,"90th_percentile":3299.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Complex GI Procedures","code_information":[{"code":"5331","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5556.09,"10th_percentile":5556.09,"90th_percentile":5940.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":815.09,"10th_percentile":815.09,"90th_percentile":815.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":29317.36,"10th_percentile":29317.36,"90th_percentile":29317.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5768.5,"10th_percentile":5768.5,"90th_percentile":5768.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17819.46,"10th_percentile":17658.09,"90th_percentile":37765.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10898.57,"10th_percentile":10898.57,"90th_percentile":10898.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13344.82,"10th_percentile":13344.82,"90th_percentile":36854.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5941.77,"10th_percentile":5536.04,"90th_percentile":6089.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":12726.39,"10th_percentile":12726.39,"90th_percentile":12726.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3507.11,"10th_percentile":3279.24,"90th_percentile":3904.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":745.04,"10th_percentile":745.04,"90th_percentile":810.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":16984.03,"10th_percentile":1966.28,"90th_percentile":40189.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3440.17,"10th_percentile":3205.62,"90th_percentile":4063.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":3495.56,"10th_percentile":2051.53,"90th_percentile":6155.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":6075.6,"10th_percentile":2569.36,"90th_percentile":12382.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":3496.44,"10th_percentile":3424.63,"90th_percentile":3854.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"70","median_amount":19530.47,"10th_percentile":5072.63,"90th_percentile":25012.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"34","median_amount":4280.44,"10th_percentile":2158.86,"90th_percentile":9007.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18955.46,"10th_percentile":12787.74,"90th_percentile":34817.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3011.28,"10th_percentile":3011.28,"90th_percentile":3011.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18351.16,"10th_percentile":18351.16,"90th_percentile":21063.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2035.36,"10th_percentile":2035.36,"90th_percentile":2035.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":3346.19,"10th_percentile":2950.7,"90th_percentile":3985.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10528.04,"10th_percentile":9974.23,"90th_percentile":12039.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2811.28,"10th_percentile":2811.28,"90th_percentile":2811.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3265.02,"10th_percentile":3265.02,"90th_percentile":6082.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2348.72,"10th_percentile":2348.72,"90th_percentile":2348.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"11","median_amount":17360.86,"10th_percentile":2531.76,"90th_percentile":24538.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":3138.09,"10th_percentile":3082.55,"90th_percentile":3866.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":21941.82,"10th_percentile":21941.82,"90th_percentile":21941.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6376.79,"10th_percentile":6376.79,"90th_percentile":6376.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":765.95,"10th_percentile":765.95,"90th_percentile":765.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":23862.22,"10th_percentile":23862.22,"90th_percentile":25513.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5533.51,"10th_percentile":5533.51,"90th_percentile":6322.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9464.98,"10th_percentile":8655.06,"90th_percentile":10612.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":5412.19,"10th_percentile":3240.34,"90th_percentile":10418.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6024.09,"10th_percentile":5962.77,"90th_percentile":6179.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":529.84,"10th_percentile":529.84,"90th_percentile":529.84},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"23","median_amount":12896.82,"10th_percentile":9415.32,"90th_percentile":34707.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"24","median_amount":4879.64,"10th_percentile":3886.22,"90th_percentile":11820.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8770.17,"10th_percentile":8770.17,"90th_percentile":19720.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22560.92,"10th_percentile":20466.27,"90th_percentile":23850.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6261.89,"10th_percentile":5915.99,"90th_percentile":6822.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20418.98,"10th_percentile":20418.98,"90th_percentile":20418.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":732.41,"10th_percentile":732.41,"90th_percentile":793.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1200.0,"10th_percentile":1200.0,"90th_percentile":1200.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":826.07,"10th_percentile":741.43,"90th_percentile":3459.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":31293.93,"10th_percentile":20969.42,"90th_percentile":78934.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6038.93,"10th_percentile":5080.85,"90th_percentile":6617.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":38307.96,"10th_percentile":38307.96,"90th_percentile":38307.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5158.19,"10th_percentile":5158.19,"90th_percentile":5158.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"35","median_amount":5760.95,"10th_percentile":5588.11,"90th_percentile":6155.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"23","median_amount":2532.59,"10th_percentile":295.6,"90th_percentile":3668.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"53","median_amount":29450.23,"10th_percentile":15530.17,"90th_percentile":44056.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":5956.34,"10th_percentile":4983.69,"90th_percentile":6338.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"44","median_amount":8425.71,"10th_percentile":3030.07,"90th_percentile":10118.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"139","median_amount":9706.5,"10th_percentile":3168.3,"90th_percentile":13815.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"42","median_amount":5647.05,"10th_percentile":5424.61,"90th_percentile":5860.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":31533.15,"10th_percentile":31533.15,"90th_percentile":31533.15},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"543","median_amount":29978.57,"10th_percentile":11492.13,"90th_percentile":40483.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"303","median_amount":8574.34,"10th_percentile":6284.82,"90th_percentile":14141.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"48","median_amount":27402.6,"10th_percentile":23425.33,"90th_percentile":33795.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"20","median_amount":2257.11,"10th_percentile":249.88,"90th_percentile":3299.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"77","median_amount":27423.99,"10th_percentile":16748.34,"90th_percentile":34755.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"14","median_amount":2266.0,"10th_percentile":798.66,"90th_percentile":3432.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"71","median_amount":5864.41,"10th_percentile":4974.47,"90th_percentile":6046.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":17417.28,"10th_percentile":16803.26,"90th_percentile":19330.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"38","median_amount":3079.99,"10th_percentile":1624.0,"90th_percentile":3599.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6730.99,"10th_percentile":6730.99,"90th_percentile":6730.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":5209.22,"10th_percentile":5209.22,"90th_percentile":5209.22},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":5660.91,"10th_percentile":5637.17,"90th_percentile":5997.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":7196.84,"10th_percentile":7196.84,"90th_percentile":17959.42},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5373.86,"10th_percentile":5329.56,"90th_percentile":5438.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"82","median_amount":2500.62,"10th_percentile":1566.2,"90th_percentile":3459.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"83","median_amount":30993.89,"10th_percentile":16892.3,"90th_percentile":42187.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3557.43,"10th_percentile":3557.43,"90th_percentile":3557.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"68","median_amount":5445.55,"10th_percentile":4657.39,"90th_percentile":6014.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"25","median_amount":31632.86,"10th_percentile":13119.58,"90th_percentile":39817.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5884.97,"10th_percentile":5884.97,"90th_percentile":5928.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Laparoscopy and Related Services","code_information":[{"code":"5362","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":10237.94,"10th_percentile":10062.05,"90th_percentile":10419.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":3000.07,"10th_percentile":958.05,"90th_percentile":3182.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"41","median_amount":38892.69,"10th_percentile":27250.62,"90th_percentile":50093.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":10681.07,"10th_percentile":8461.1,"90th_percentile":10944.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":16364.37,"10th_percentile":10224.02,"90th_percentile":17964.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"69","median_amount":11373.61,"10th_percentile":4804.74,"90th_percentile":24621.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":9926.49,"10th_percentile":9709.91,"90th_percentile":10231.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":73452.58,"10th_percentile":73452.58,"90th_percentile":73452.58},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"362","median_amount":31231.46,"10th_percentile":12129.55,"90th_percentile":60755.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"209","median_amount":10253.36,"10th_percentile":7994.46,"90th_percentile":28501.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":28227.27,"10th_percentile":20858.07,"90th_percentile":72155.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":2765.35,"10th_percentile":1470.32,"90th_percentile":2796.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"46","median_amount":28662.78,"10th_percentile":1585.63,"90th_percentile":46303.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":10332.47,"10th_percentile":10332.47,"90th_percentile":10332.47},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2113.31,"10th_percentile":2113.31,"90th_percentile":2884.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"51","median_amount":10097.23,"10th_percentile":8354.04,"90th_percentile":10551.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":32172.79,"10th_percentile":31456.22,"90th_percentile":34275.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"24","median_amount":3060.47,"10th_percentile":2151.97,"90th_percentile":3820.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"39","median_amount":10081.88,"10th_percentile":9915.11,"90th_percentile":10458.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":9502.51,"10th_percentile":9502.51,"90th_percentile":9502.51},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"39","median_amount":2866.37,"10th_percentile":616.88,"90th_percentile":3318.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"61","median_amount":42961.29,"10th_percentile":32067.75,"90th_percentile":54905.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17753.28,"10th_percentile":17753.28,"90th_percentile":17753.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":9920.39,"10th_percentile":8214.45,"90th_percentile":10389.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"12","median_amount":44954.51,"10th_percentile":34903.95,"90th_percentile":49387.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10103.78,"10th_percentile":10056.06,"90th_percentile":10497.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":7020.22,"10th_percentile":7020.22,"90th_percentile":7020.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":452.67,"10th_percentile":452.67,"90th_percentile":452.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":385.58,"10th_percentile":385.58,"90th_percentile":385.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":10383.87,"10th_percentile":10383.87,"90th_percentile":10383.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":854.14,"10th_percentile":854.14,"90th_percentile":854.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1335.79,"10th_percentile":1335.79,"90th_percentile":1335.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4104.39,"10th_percentile":4104.39,"90th_percentile":4104.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":426.17,"10th_percentile":426.17,"90th_percentile":426.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4944.72,"10th_percentile":4790.6,"90th_percentile":11705.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1718.01,"10th_percentile":1718.01,"90th_percentile":1718.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":756.32,"10th_percentile":756.32,"90th_percentile":756.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":10781.74,"10th_percentile":10781.74,"90th_percentile":10781.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":740.75,"10th_percentile":740.75,"90th_percentile":750.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3815.6,"10th_percentile":3815.6,"90th_percentile":3815.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":410.32,"10th_percentile":410.32,"90th_percentile":410.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":2047.25,"10th_percentile":1712.6,"90th_percentile":2246.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1516.75,"10th_percentile":541.26,"90th_percentile":1950.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":16386.26,"10th_percentile":13936.37,"90th_percentile":18788.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1816.84,"10th_percentile":1589.88,"90th_percentile":2195.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":3549.89,"10th_percentile":2558.57,"90th_percentile":4453.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"21","median_amount":3374.07,"10th_percentile":1574.2,"90th_percentile":5581.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":2007.98,"10th_percentile":1723.66,"90th_percentile":2035.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"54","median_amount":12833.86,"10th_percentile":7198.51,"90th_percentile":16147.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"32","median_amount":2304.96,"10th_percentile":1197.63,"90th_percentile":5316.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17386.7,"10th_percentile":17386.7,"90th_percentile":17386.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":376.82,"10th_percentile":301.82,"90th_percentile":594.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12284.31,"10th_percentile":9582.6,"90th_percentile":15746.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":1968.77,"10th_percentile":1527.77,"90th_percentile":2238.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6116.32,"10th_percentile":5871.04,"90th_percentile":6842.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":308.41,"10th_percentile":308.41,"90th_percentile":2313.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":1996.12,"10th_percentile":1895.24,"90th_percentile":2083.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1903.86,"10th_percentile":1903.86,"90th_percentile":1903.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1460.4,"10th_percentile":1439.24,"90th_percentile":2285.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"16","median_amount":11135.13,"10th_percentile":4634.12,"90th_percentile":14713.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"62","median_amount":1931.63,"10th_percentile":1556.44,"90th_percentile":2040.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":11815.55,"10th_percentile":11067.63,"90th_percentile":14360.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2041.85,"10th_percentile":2041.85,"90th_percentile":2169.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":3392.91,"10th_percentile":3179.03,"90th_percentile":3508.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1736.31,"10th_percentile":1514.4,"90th_percentile":3557.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"15","median_amount":18672.86,"10th_percentile":7978.66,"90th_percentile":36442.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":3398.59,"10th_percentile":3156.81,"90th_percentile":3823.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5554.93,"10th_percentile":4575.64,"90th_percentile":7105.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"35","median_amount":6557.63,"10th_percentile":801.59,"90th_percentile":11710.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"34","median_amount":3315.52,"10th_percentile":3031.22,"90th_percentile":3657.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"127","median_amount":19973.19,"10th_percentile":13831.76,"90th_percentile":34173.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"62","median_amount":5126.92,"10th_percentile":2490.29,"90th_percentile":9238.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18370.74,"10th_percentile":14906.42,"90th_percentile":25666.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1385.79,"10th_percentile":1364.73,"90th_percentile":3380.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"11","median_amount":19874.16,"10th_percentile":13228.25,"90th_percentile":27264.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3000.43,"10th_percentile":3000.43,"90th_percentile":3000.43},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2212.44,"10th_percentile":2212.44,"90th_percentile":2727.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"72","median_amount":3467.8,"10th_percentile":3000.73,"90th_percentile":3678.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":16373.91,"10th_percentile":16373.91,"90th_percentile":16373.91},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10121.38,"10th_percentile":9440.35,"90th_percentile":10539.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2446.87,"10th_percentile":2103.03,"90th_percentile":3773.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":3473.72,"10th_percentile":3307.62,"90th_percentile":6388.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2353.55,"10th_percentile":1545.04,"90th_percentile":3288.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"29","median_amount":17522.07,"10th_percentile":489.0,"90th_percentile":26761.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"70","median_amount":3384.51,"10th_percentile":2817.33,"90th_percentile":3668.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":22933.39,"10th_percentile":19800.88,"90th_percentile":35911.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3238.67,"10th_percentile":3159.85,"90th_percentile":3543.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":5126.15,"10th_percentile":4903.35,"90th_percentile":6103.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2332.5,"10th_percentile":708.47,"90th_percentile":3785.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"25","median_amount":24091.48,"10th_percentile":18117.31,"90th_percentile":33506.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":5551.13,"10th_percentile":4792.98,"90th_percentile":12084.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":8687.41,"10th_percentile":4357.53,"90th_percentile":11484.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"85","median_amount":6458.08,"10th_percentile":3864.46,"90th_percentile":12703.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"51","median_amount":5042.4,"10th_percentile":4612.54,"90th_percentile":10360.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":18579.33,"10th_percentile":18579.33,"90th_percentile":18579.33},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"290","median_amount":16104.29,"10th_percentile":8949.95,"90th_percentile":34854.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"169","median_amount":8136.16,"10th_percentile":5548.54,"90th_percentile":14341.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"26","median_amount":20275.31,"10th_percentile":10721.59,"90th_percentile":44723.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":674.3,"10th_percentile":637.55,"90th_percentile":2166.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"45","median_amount":26569.04,"10th_percentile":20784.2,"90th_percentile":35366.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":675.42,"10th_percentile":675.42,"90th_percentile":675.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"135","median_amount":5188.76,"10th_percentile":4635.23,"90th_percentile":8965.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":18318.1,"10th_percentile":14738.81,"90th_percentile":41352.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":736.91,"10th_percentile":662.45,"90th_percentile":2383.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"63","median_amount":5833.18,"10th_percentile":4892.18,"90th_percentile":12123.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":16797.5,"10th_percentile":16797.5,"90th_percentile":33042.11},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4680.56,"10th_percentile":4680.56,"90th_percentile":4680.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"27","median_amount":920.21,"10th_percentile":676.3,"90th_percentile":2570.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"45","median_amount":25342.14,"10th_percentile":1098.57,"90th_percentile":39090.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"89","median_amount":5084.03,"10th_percentile":4176.7,"90th_percentile":6176.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":24664.74,"10th_percentile":21837.51,"90th_percentile":50420.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":5185.65,"10th_percentile":4758.92,"90th_percentile":6150.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Urology and Related Services","code_information":[{"code":"5376","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1130.52,"10th_percentile":1130.52,"90th_percentile":1130.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9095.53,"10th_percentile":9095.53,"90th_percentile":9095.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":15759.5,"10th_percentile":15759.5,"90th_percentile":15759.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14471.34,"10th_percentile":14471.34,"90th_percentile":26023.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8784.72,"10th_percentile":8548.1,"90th_percentile":8818.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":47069.34,"10th_percentile":44068.47,"90th_percentile":69285.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14692.56,"10th_percentile":14336.63,"90th_percentile":15986.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41952.86,"10th_percentile":41952.86,"90th_percentile":41952.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31188.06,"10th_percentile":31188.06,"90th_percentile":31188.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9178.71,"10th_percentile":9044.39,"90th_percentile":10193.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27906.88,"10th_percentile":27906.88,"90th_percentile":27906.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2156.76,"10th_percentile":2156.76,"90th_percentile":2156.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8766.94,"10th_percentile":8766.94,"90th_percentile":8766.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":11977.39,"10th_percentile":11977.39,"90th_percentile":11977.39},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1895.98,"10th_percentile":1895.98,"90th_percentile":1895.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":41123.35,"10th_percentile":41123.35,"90th_percentile":41123.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9062.19,"10th_percentile":9062.19,"90th_percentile":9135.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 7 Urology and Related Services","code_information":[{"code":"5377","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21941.21,"10th_percentile":21941.21,"90th_percentile":21941.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":19780.53,"10th_percentile":19780.53,"90th_percentile":19780.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1582.67,"10th_percentile":1582.67,"90th_percentile":1582.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12202.31,"10th_percentile":12202.31,"90th_percentile":12202.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10105.78,"10th_percentile":10105.78,"90th_percentile":10105.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 8 Urology and Related Services","code_information":[{"code":"5378","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19206.7,"10th_percentile":19206.7,"90th_percentile":19206.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":346.39,"10th_percentile":346.39,"90th_percentile":346.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":16063.23,"10th_percentile":16063.23,"90th_percentile":16063.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19904.06,"10th_percentile":19904.06,"90th_percentile":19904.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34606.03,"10th_percentile":34606.03,"90th_percentile":34606.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18925.18,"10th_percentile":18925.18,"90th_percentile":18925.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":75516.97,"10th_percentile":65144.15,"90th_percentile":98060.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30654.07,"10th_percentile":30332.33,"90th_percentile":35277.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":19586.91,"10th_percentile":19200.39,"90th_percentile":19719.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17717.39,"10th_percentile":17717.39,"90th_percentile":17717.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18840.12,"10th_percentile":18834.2,"90th_percentile":18846.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":402.03,"10th_percentile":402.03,"90th_percentile":402.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":51062.19,"10th_percentile":51062.19,"90th_percentile":51062.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19218.38,"10th_percentile":18848.08,"90th_percentile":19282.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dialysis","code_information":[{"code":"5401","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":202.94,"10th_percentile":202.94,"90th_percentile":202.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1877.12,"10th_percentile":1877.12,"90th_percentile":1877.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3084.86,"10th_percentile":3084.86,"90th_percentile":3084.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10179.06,"10th_percentile":10179.06,"90th_percentile":10179.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10757.89,"10th_percentile":10757.89,"90th_percentile":10757.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18793.76,"10th_percentile":18793.76,"90th_percentile":18793.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6848.21,"10th_percentile":6848.21,"90th_percentile":6848.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":2710.35,"10th_percentile":2522.97,"90th_percentile":5262.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2811.45,"10th_percentile":2811.45,"90th_percentile":6166.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":991.21,"10th_percentile":991.21,"90th_percentile":991.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":9744.62,"10th_percentile":9744.62,"90th_percentile":9744.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":2857.31,"10th_percentile":2663.9,"90th_percentile":7691.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":221.39,"10th_percentile":221.39,"90th_percentile":221.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":325.47,"10th_percentile":325.47,"90th_percentile":325.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"12","median_amount":937.84,"10th_percentile":750.28,"90th_percentile":15359.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":292.34,"10th_percentile":9.3,"90th_percentile":958.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1927.84,"10th_percentile":1927.84,"90th_percentile":1927.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":221.39,"10th_percentile":221.39,"90th_percentile":221.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":205.2,"10th_percentile":205.2,"90th_percentile":205.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":284.5,"10th_percentile":284.5,"90th_percentile":284.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":233.3,"10th_percentile":233.3,"90th_percentile":562.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Gynecologic Procedures","code_information":[{"code":"5412","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":622.76,"10th_percentile":622.76,"90th_percentile":622.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2481.02,"10th_percentile":1702.55,"90th_percentile":7185.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4537.79,"10th_percentile":749.1,"90th_percentile":4553.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1907.78,"10th_percentile":1907.78,"90th_percentile":1907.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1536.91,"10th_percentile":1536.91,"90th_percentile":1536.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1494.23,"10th_percentile":1494.23,"90th_percentile":1546.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":665.45,"10th_percentile":665.45,"90th_percentile":665.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Gynecologic Procedures","code_information":[{"code":"5413","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":9413.98,"10th_percentile":9413.98,"90th_percentile":9413.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1673.4,"10th_percentile":1673.4,"90th_percentile":1673.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4305.1,"10th_percentile":3870.19,"90th_percentile":5247.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":14285.46,"10th_percentile":14285.46,"90th_percentile":14285.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3145.72,"10th_percentile":2820.79,"90th_percentile":3154.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":1625.03,"10th_percentile":1579.54,"90th_percentile":3719.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"30","median_amount":15136.2,"10th_percentile":10914.38,"90th_percentile":23987.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3288.09,"10th_percentile":2932.76,"90th_percentile":3325.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":4137.37,"10th_percentile":1382.78,"90th_percentile":5790.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"69","median_amount":3869.27,"10th_percentile":1576.63,"90th_percentile":5780.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2895.84,"10th_percentile":2828.6,"90th_percentile":3107.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":14195.81,"10th_percentile":14195.81,"90th_percentile":21481.29},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"257","median_amount":13585.45,"10th_percentile":10409.08,"90th_percentile":17775.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"163","median_amount":2573.13,"10th_percentile":1916.1,"90th_percentile":6014.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":12222.01,"10th_percentile":10580.7,"90th_percentile":17200.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1405.04,"10th_percentile":175.96,"90th_percentile":3437.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"36","median_amount":19328.56,"10th_percentile":13873.59,"90th_percentile":23757.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1523.96,"10th_percentile":1475.53,"90th_percentile":3457.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":2824.1,"10th_percentile":2614.44,"90th_percentile":3235.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":17845.6,"10th_percentile":17845.6,"90th_percentile":17845.6},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":9146.12,"10th_percentile":8765.27,"90th_percentile":9518.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"37","median_amount":1573.51,"10th_percentile":1536.03,"90th_percentile":2348.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3247.66,"10th_percentile":3247.66,"90th_percentile":3247.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":4118.3,"10th_percentile":4118.3,"90th_percentile":6692.16},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2925.0,"10th_percentile":2925.0,"90th_percentile":2925.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"42","median_amount":1515.4,"10th_percentile":1458.7,"90th_percentile":1702.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"54","median_amount":14748.58,"10th_percentile":993.3,"90th_percentile":21047.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":2763.87,"10th_percentile":2538.41,"90th_percentile":3161.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"15","median_amount":14836.52,"10th_percentile":7643.6,"90th_percentile":19231.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3060.56,"10th_percentile":3001.01,"90th_percentile":3245.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4912.75,"10th_percentile":4912.75,"90th_percentile":4912.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":23560.44,"10th_percentile":13470.37,"90th_percentile":44187.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4945.05,"10th_percentile":4764.91,"90th_percentile":5250.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4431.18,"10th_percentile":403.63,"90th_percentile":6665.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":8622.23,"10th_percentile":4301.06,"90th_percentile":16002.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4762.92,"10th_percentile":4494.42,"90th_percentile":4927.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"59","median_amount":24019.73,"10th_percentile":19404.42,"90th_percentile":39032.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"40","median_amount":7327.93,"10th_percentile":5788.01,"90th_percentile":12974.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21321.41,"10th_percentile":16201.67,"90th_percentile":26850.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"16","median_amount":23710.99,"10th_percentile":18166.43,"90th_percentile":37136.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4620.79,"10th_percentile":4536.13,"90th_percentile":5024.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14594.35,"10th_percentile":14594.35,"90th_percentile":14594.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2495.87,"10th_percentile":2423.09,"90th_percentile":3838.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2482.92,"10th_percentile":2482.92,"90th_percentile":2482.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"12","median_amount":20733.93,"10th_percentile":16626.7,"90th_percentile":29023.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4878.43,"10th_percentile":4878.43,"90th_percentile":4878.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":23934.8,"10th_percentile":1174.78,"90th_percentile":35137.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4735.86,"10th_percentile":4735.86,"90th_percentile":4735.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Gynecologic Procedures","code_information":[{"code":"5416","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7207.73,"10th_percentile":7202.13,"90th_percentile":7239.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12591.67,"10th_percentile":12591.67,"90th_percentile":12591.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18334.26,"10th_percentile":18334.26,"90th_percentile":18334.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6931.93,"10th_percentile":6931.93,"90th_percentile":6963.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":35500.07,"10th_percentile":26732.1,"90th_percentile":38158.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1564.69,"10th_percentile":1564.69,"90th_percentile":1564.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7362.65,"10th_percentile":7004.62,"90th_percentile":7445.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7067.64,"10th_percentile":7067.64,"90th_percentile":7067.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2412.2,"10th_percentile":2412.2,"90th_percentile":2412.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":30510.12,"10th_percentile":30510.12,"90th_percentile":30510.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6859.99,"10th_percentile":6859.99,"90th_percentile":7250.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7532.55,"10th_percentile":7532.55,"90th_percentile":7532.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":141.94,"10th_percentile":141.94,"90th_percentile":141.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2400.68,"10th_percentile":2400.68,"90th_percentile":2400.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":5614.76,"10th_percentile":5614.76,"90th_percentile":5614.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2047.57,"10th_percentile":2009.81,"90th_percentile":2069.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2563.61,"10th_percentile":2563.61,"90th_percentile":2563.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2741.96,"10th_percentile":885.4,"90th_percentile":4501.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1903.58,"10th_percentile":1903.58,"90th_percentile":1903.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":12048.49,"10th_percentile":10773.59,"90th_percentile":13209.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1249.23,"10th_percentile":986.26,"90th_percentile":1382.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12653.15,"10th_percentile":11296.72,"90th_percentile":15101.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16363.44,"10th_percentile":16363.44,"90th_percentile":16363.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2132.38,"10th_percentile":2132.38,"90th_percentile":2132.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2055.08,"10th_percentile":2055.08,"90th_percentile":2142.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5657.55,"10th_percentile":5657.55,"90th_percentile":5657.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2313.65,"10th_percentile":2313.65,"90th_percentile":2313.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":12083.6,"10th_percentile":12083.6,"90th_percentile":16029.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1951.94,"10th_percentile":1571.52,"90th_percentile":1978.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38660.19,"10th_percentile":38660.19,"90th_percentile":38660.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14371.48,"10th_percentile":14371.48,"90th_percentile":29711.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"38","median_amount":284.02,"10th_percentile":9.71,"90th_percentile":293.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":490.98,"10th_percentile":490.98,"90th_percentile":627.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":1417.64,"10th_percentile":1417.64,"90th_percentile":1417.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":296.44,"10th_percentile":50.0,"90th_percentile":302.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.79,"10th_percentile":234.76,"90th_percentile":1080.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"21","median_amount":490.67,"10th_percentile":40.0,"90th_percentile":568.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":277.5,"10th_percentile":49.49,"90th_percentile":282.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"89","median_amount":1568.96,"10th_percentile":277.94,"90th_percentile":1568.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"57","median_amount":479.4,"10th_percentile":291.52,"90th_percentile":479.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"12","median_amount":1219.04,"10th_percentile":1027.33,"90th_percentile":1491.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1968.98,"10th_percentile":859.64,"90th_percentile":3309.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":446.35,"10th_percentile":446.35,"90th_percentile":446.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":293.68,"10th_percentile":151.7,"90th_percentile":444.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":829.11,"10th_percentile":744.74,"90th_percentile":1294.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":482.06,"10th_percentile":482.06,"90th_percentile":701.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":13.6,"10th_percentile":13.6,"90th_percentile":13.6},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":281.9,"10th_percentile":273.1,"90th_percentile":428.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":326.62,"10th_percentile":326.62,"90th_percentile":326.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":468.67,"10th_percentile":468.67,"90th_percentile":703.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"16","median_amount":1429.09,"10th_percentile":922.44,"90th_percentile":2033.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"61","median_amount":284.31,"10th_percentile":9.79,"90th_percentile":426.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":1279.48,"10th_percentile":1251.21,"90th_percentile":1389.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":296.37,"10th_percentile":287.54,"90th_percentile":380.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":653.02,"10th_percentile":592.17,"90th_percentile":660.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":490.98,"10th_percentile":490.98,"90th_percentile":4375.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":3695.38,"10th_percentile":3414.69,"90th_percentile":8604.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":923.81,"10th_percentile":537.48,"90th_percentile":1272.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1153.28,"10th_percentile":864.96,"90th_percentile":1160.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"21","median_amount":1540.16,"10th_percentile":339.6,"90th_percentile":3118.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":640.71,"10th_percentile":640.71,"90th_percentile":1811.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2815.05,"10th_percentile":2815.05,"90th_percentile":2815.05},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"73","median_amount":3589.92,"10th_percentile":1866.55,"90th_percentile":8431.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"44","median_amount":1085.78,"10th_percentile":689.01,"90th_percentile":3438.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4271.68,"10th_percentile":4271.68,"90th_percentile":15234.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":958.35,"10th_percentile":267.7,"90th_percentile":1919.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"12","median_amount":6207.19,"10th_percentile":4962.0,"90th_percentile":13932.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":532.45,"10th_percentile":224.57,"90th_percentile":1940.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2024.0,"10th_percentile":1799.11,"90th_percentile":2024.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":482.06,"10th_percentile":187.32,"90th_percentile":2363.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1059.44,"10th_percentile":640.71,"90th_percentile":2367.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4214.56,"10th_percentile":4214.56,"90th_percentile":4214.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":895.12,"10th_percentile":562.23,"90th_percentile":1817.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":3261.03,"10th_percentile":954.61,"90th_percentile":9569.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":527.44,"10th_percentile":265.92,"90th_percentile":660.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3911.03,"10th_percentile":3640.11,"90th_percentile":10565.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":674.59,"10th_percentile":537.48,"90th_percentile":677.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":500.84,"10th_percentile":500.84,"90th_percentile":500.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2005.82,"10th_percentile":2005.82,"90th_percentile":2005.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3850.67,"10th_percentile":3850.67,"90th_percentile":4668.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2774.53,"10th_percentile":2774.53,"90th_percentile":2774.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5288.75,"10th_percentile":5288.75,"90th_percentile":5288.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9581.36,"10th_percentile":9581.36,"90th_percentile":9581.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":869.21,"10th_percentile":869.21,"90th_percentile":869.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":687.77,"10th_percentile":687.77,"90th_percentile":687.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":6847.49,"10th_percentile":6847.49,"90th_percentile":6847.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":221.94,"10th_percentile":221.94,"90th_percentile":221.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3353.78,"10th_percentile":3353.78,"90th_percentile":3353.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30565.87,"10th_percentile":30565.87,"90th_percentile":30565.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3695.11,"10th_percentile":3468.01,"90th_percentile":3732.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3488.3,"10th_percentile":3488.3,"90th_percentile":3488.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3582.62,"10th_percentile":3582.62,"90th_percentile":3582.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":228.27,"10th_percentile":228.27,"90th_percentile":228.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20805.14,"10th_percentile":20805.14,"90th_percentile":20805.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":43467.11,"10th_percentile":43467.11,"90th_percentile":43467.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19921.54,"10th_percentile":19921.54,"90th_percentile":19921.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":63066.88,"10th_percentile":37656.0,"90th_percentile":100067.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36600.71,"10th_percentile":36600.71,"90th_percentile":41429.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25889.58,"10th_percentile":25889.58,"90th_percentile":25889.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20778.43,"10th_percentile":20316.87,"90th_percentile":20830.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":67982.89,"10th_percentile":67982.89,"90th_percentile":67982.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20033.76,"10th_percentile":20033.76,"90th_percentile":20033.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":55137.84,"10th_percentile":55137.84,"90th_percentile":55137.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":48700.95,"10th_percentile":48700.95,"90th_percentile":48700.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18769.65,"10th_percentile":17610.36,"90th_percentile":20492.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20625.0,"10th_percentile":20625.0,"90th_percentile":20625.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":361.08,"10th_percentile":361.08,"90th_percentile":361.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":87568.57,"10th_percentile":87568.57,"90th_percentile":87568.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29654.86,"10th_percentile":29654.86,"90th_percentile":29654.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29115.1,"10th_percentile":29115.1,"90th_percentile":29115.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5502","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1546.82,"10th_percentile":1546.82,"90th_percentile":1546.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"126","median_amount":162.13,"10th_percentile":81.64,"90th_percentile":202.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"62","median_amount":295.54,"10th_percentile":66.99,"90th_percentile":600.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"147","median_amount":709.59,"10th_percentile":179.06,"90th_percentile":892.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"105","median_amount":181.35,"10th_percentile":80.11,"90th_percentile":203.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"117","median_amount":244.69,"10th_percentile":74.79,"90th_percentile":380.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"476","median_amount":201.52,"10th_percentile":87.0,"90th_percentile":388.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"130","median_amount":159.07,"10th_percentile":81.46,"90th_percentile":194.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":468.6,"10th_percentile":408.9,"90th_percentile":1555.78},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1864","median_amount":730.84,"10th_percentile":234.88,"90th_percentile":1011.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1162","median_amount":303.5,"10th_percentile":60.9,"90th_percentile":494.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"156","median_amount":805.07,"10th_percentile":386.96,"90th_percentile":1001.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"47","median_amount":268.67,"10th_percentile":42.42,"90th_percentile":587.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"244","median_amount":784.2,"10th_percentile":203.93,"90th_percentile":1267.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":2602.64,"10th_percentile":2602.64,"90th_percentile":2602.64},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":234.13,"10th_percentile":33.53,"90th_percentile":504.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"284","median_amount":117.12,"10th_percentile":84.62,"90th_percentile":203.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":529.55,"10th_percentile":529.55,"90th_percentile":529.55},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"110","median_amount":558.33,"10th_percentile":257.33,"90th_percentile":632.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"109","median_amount":290.16,"10th_percentile":109.13,"90th_percentile":606.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":182.71,"10th_percentile":182.71,"90th_percentile":182.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"145","median_amount":305.07,"10th_percentile":81.46,"90th_percentile":326.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":316.3,"10th_percentile":100.95,"90th_percentile":875.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":87.16,"10th_percentile":87.16,"90th_percentile":87.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":261.47,"10th_percentile":76.64,"90th_percentile":859.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"214","median_amount":245.83,"10th_percentile":43.73,"90th_percentile":488.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"335","median_amount":705.0,"10th_percentile":272.0,"90th_percentile":1108.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":271.02,"10th_percentile":271.02,"90th_percentile":271.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"271","median_amount":176.29,"10th_percentile":67.07,"90th_percentile":234.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"81","median_amount":1048.62,"10th_percentile":313.64,"90th_percentile":1064.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":167.15,"10th_percentile":85.42,"90th_percentile":191.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"153","median_amount":102.32,"10th_percentile":99.85,"90th_percentile":238.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"36","median_amount":172.47,"10th_percentile":91.98,"90th_percentile":758.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"111","median_amount":778.62,"10th_percentile":343.3,"90th_percentile":1411.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"172","median_amount":103.44,"10th_percentile":89.44,"90th_percentile":211.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"79","median_amount":177.08,"10th_percentile":88.54,"90th_percentile":585.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"313","median_amount":243.28,"10th_percentile":106.59,"90th_percentile":371.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"256","median_amount":98.38,"10th_percentile":98.38,"90th_percentile":201.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":660.23,"10th_percentile":660.23,"90th_percentile":886.09},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1369","median_amount":872.76,"10th_percentile":349.91,"90th_percentile":1454.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"778","median_amount":193.81,"10th_percentile":67.2,"90th_percentile":352.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"80","median_amount":809.96,"10th_percentile":475.21,"90th_percentile":1175.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"27","median_amount":217.67,"10th_percentile":111.2,"90th_percentile":689.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"142","median_amount":512.04,"10th_percentile":271.91,"90th_percentile":1143.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":282.07,"10th_percentile":282.07,"90th_percentile":282.07},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":156.79,"10th_percentile":112.72,"90th_percentile":290.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"359","median_amount":103.19,"10th_percentile":102.19,"90th_percentile":221.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"79","median_amount":315.31,"10th_percentile":228.55,"90th_percentile":692.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"104","median_amount":169.33,"10th_percentile":115.7,"90th_percentile":744.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98.6,"10th_percentile":98.6,"90th_percentile":98.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"99","median_amount":98.38,"10th_percentile":98.38,"90th_percentile":343.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":137.73,"10th_percentile":127.89,"90th_percentile":1149.2},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":168.26,"10th_percentile":103.59,"90th_percentile":211.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":934.13,"10th_percentile":934.13,"90th_percentile":934.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":116.17,"10th_percentile":115.7,"90th_percentile":301.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"96","median_amount":164.63,"10th_percentile":118.36,"90th_percentile":723.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"184","median_amount":700.0,"10th_percentile":394.84,"90th_percentile":1064.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"366","median_amount":100.54,"10th_percentile":98.6,"90th_percentile":205.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"56","median_amount":700.0,"10th_percentile":269.76,"90th_percentile":1064.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"58","median_amount":104.66,"10th_percentile":63.96,"90th_percentile":211.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"51","median_amount":231.03,"10th_percentile":17.23,"90th_percentile":372.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":979.29,"10th_percentile":758.08,"90th_percentile":1093.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"19","median_amount":1517.17,"10th_percentile":1118.59,"90th_percentile":9004.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":236.89,"10th_percentile":78.49,"90th_percentile":328.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"30","median_amount":316.26,"10th_percentile":201.26,"90th_percentile":549.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"65","median_amount":448.48,"10th_percentile":200.08,"90th_percentile":1016.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"65","median_amount":223.63,"10th_percentile":212.44,"90th_percentile":499.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"280","median_amount":2159.37,"10th_percentile":944.76,"90th_percentile":3216.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"134","median_amount":366.48,"10th_percentile":180.0,"90th_percentile":698.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":1290.92,"10th_percentile":792.35,"90th_percentile":1342.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"17","median_amount":890.26,"10th_percentile":689.17,"90th_percentile":1114.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"24","median_amount":1026.12,"10th_percentile":810.83,"90th_percentile":3806.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"126","median_amount":233.31,"10th_percentile":183.31,"90th_percentile":525.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"38","median_amount":784.94,"10th_percentile":667.2,"90th_percentile":1481.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"14","median_amount":961.49,"10th_percentile":744.3,"90th_percentile":1096.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"69","median_amount":223.63,"10th_percentile":223.63,"90th_percentile":499.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1815.43,"10th_percentile":1815.43,"90th_percentile":1815.43},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":235.45,"10th_percentile":235.45,"90th_percentile":239.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":219.16,"10th_percentile":219.16,"90th_percentile":219.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":262.73,"10th_percentile":262.73,"90th_percentile":262.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"25","median_amount":934.78,"10th_percentile":723.63,"90th_percentile":1565.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"41","median_amount":1561.81,"10th_percentile":308.93,"90th_percentile":3078.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"184","median_amount":228.83,"10th_percentile":7.43,"90th_percentile":459.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3073.0,"10th_percentile":1199.09,"90th_percentile":3778.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":234.49,"10th_percentile":3.92,"90th_percentile":448.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":680.52,"10th_percentile":520.12,"90th_percentile":733.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1614.94,"10th_percentile":1099.48,"90th_percentile":3586.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"14","median_amount":2821.47,"10th_percentile":1884.99,"90th_percentile":4727.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":747.45,"10th_percentile":531.93,"90th_percentile":836.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":871.74,"10th_percentile":456.55,"90th_percentile":2295.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"58","median_amount":1035.37,"10th_percentile":389.93,"90th_percentile":1586.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":659.58,"10th_percentile":507.28,"90th_percentile":1005.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"183","median_amount":4107.11,"10th_percentile":2338.79,"90th_percentile":6183.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"97","median_amount":887.4,"10th_percentile":617.92,"90th_percentile":1279.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"13","median_amount":3904.4,"10th_percentile":3504.02,"90th_percentile":7395.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":747.47,"10th_percentile":407.95,"90th_percentile":1563.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"21","median_amount":2254.71,"10th_percentile":115.83,"90th_percentile":6693.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":222.74,"10th_percentile":222.74,"90th_percentile":222.74},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"76","median_amount":696.29,"10th_percentile":454.57,"90th_percentile":931.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":1513.13,"10th_percentile":273.1,"90th_percentile":1611.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"19","median_amount":450.46,"10th_percentile":401.08,"90th_percentile":1423.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":669.48,"10th_percentile":507.28,"90th_percentile":2732.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":426.12,"10th_percentile":130.0,"90th_percentile":710.19},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.99,"10th_percentile":645.99,"90th_percentile":652.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"29","median_amount":437.94,"10th_percentile":389.93,"90th_percentile":834.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"32","median_amount":3168.42,"10th_percentile":2243.66,"90th_percentile":4511.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"67","median_amount":675.42,"10th_percentile":417.59,"90th_percentile":749.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"12","median_amount":3127.17,"10th_percentile":301.74,"90th_percentile":3884.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":696.79,"10th_percentile":567.63,"90th_percentile":762.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"62","median_amount":168.27,"10th_percentile":145.6,"90th_percentile":295.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":103.58,"10th_percentile":103.58,"90th_percentile":521.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"37","median_amount":678.35,"10th_percentile":350.0,"90th_percentile":1592.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"44","median_amount":172.99,"10th_percentile":158.99,"90th_percentile":345.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":296.46,"10th_percentile":148.23,"90th_percentile":479.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"72","median_amount":236.84,"10th_percentile":185.02,"90th_percentile":866.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"76","median_amount":164.7,"10th_percentile":137.84,"90th_percentile":328.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":736.0,"10th_percentile":736.0,"90th_percentile":736.0},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"324","median_amount":766.46,"10th_percentile":588.8,"90th_percentile":3146.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"172","median_amount":140.67,"10th_percentile":38.87,"90th_percentile":619.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":736.0,"10th_percentile":477.03,"90th_percentile":2834.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":221.59,"10th_percentile":94.16,"90th_percentile":704.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"33","median_amount":512.04,"10th_percentile":405.13,"90th_percentile":575.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":94.16,"10th_percentile":94.16,"90th_percentile":1035.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"166","median_amount":173.69,"10th_percentile":43.69,"90th_percentile":424.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":578.1,"10th_percentile":435.17,"90th_percentile":1201.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"19","median_amount":125.25,"10th_percentile":101.7,"90th_percentile":1078.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":250.0,"10th_percentile":250.0,"90th_percentile":250.0},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":164.7,"10th_percentile":164.7,"90th_percentile":164.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":230.58,"10th_percentile":230.58,"90th_percentile":230.58},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":173.41,"10th_percentile":173.41,"90th_percentile":173.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.19,"10th_percentile":165.19,"90th_percentile":347.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"54","median_amount":121.77,"10th_percentile":98.87,"90th_percentile":614.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"42","median_amount":705.0,"10th_percentile":570.0,"90th_percentile":2625.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"188","median_amount":167.87,"10th_percentile":135.59,"90th_percentile":336.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"12","median_amount":705.0,"10th_percentile":684.0,"90th_percentile":2100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":168.55,"10th_percentile":110.84,"90th_percentile":418.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"89","median_amount":339.86,"10th_percentile":135.86,"90th_percentile":884.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"18","median_amount":672.51,"10th_percentile":272.95,"90th_percentile":2827.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"29","median_amount":3490.5,"10th_percentile":829.31,"90th_percentile":7340.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"57","median_amount":347.88,"10th_percentile":150.47,"90th_percentile":829.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":604.51,"10th_percentile":379.15,"90th_percentile":1439.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"77","median_amount":1508.72,"10th_percentile":634.22,"90th_percentile":2812.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"89","median_amount":330.41,"10th_percentile":90.41,"90th_percentile":790.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":3750.97,"10th_percentile":3750.97,"90th_percentile":3750.97},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"559","median_amount":4688.71,"10th_percentile":2070.59,"90th_percentile":5624.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"330","median_amount":1186.67,"10th_percentile":665.02,"90th_percentile":1762.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"30","median_amount":3940.24,"10th_percentile":1425.4,"90th_percentile":4872.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"17","median_amount":598.24,"10th_percentile":249.34,"90th_percentile":2013.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"35","median_amount":5022.38,"10th_percentile":1702.5,"90th_percentile":7734.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":581.53,"10th_percentile":581.53,"90th_percentile":581.53},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":602.0,"10th_percentile":571.16,"90th_percentile":2029.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"194","median_amount":349.73,"10th_percentile":24.73,"90th_percentile":934.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":9360.37,"10th_percentile":9360.37,"90th_percentile":9360.37},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1159.74,"10th_percentile":869.81,"90th_percentile":4175.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"24","median_amount":794.82,"10th_percentile":316.17,"90th_percentile":2763.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1310.42,"10th_percentile":1310.42,"90th_percentile":1310.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"74","median_amount":330.41,"10th_percentile":330.41,"90th_percentile":790.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":770.0,"10th_percentile":770.0,"90th_percentile":770.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":532.04,"10th_percentile":532.04,"90th_percentile":532.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":736.54,"10th_percentile":736.54,"90th_percentile":736.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":390.15,"10th_percentile":390.15,"90th_percentile":584.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"67","median_amount":618.99,"10th_percentile":57.08,"90th_percentile":2126.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"97","median_amount":3073.0,"10th_percentile":1293.78,"90th_percentile":4139.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":271.02,"10th_percentile":271.02,"90th_percentile":271.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"187","median_amount":340.16,"10th_percentile":121.26,"90th_percentile":809.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"20","median_amount":2982.61,"10th_percentile":1380.0,"90th_percentile":5521.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":352.47,"10th_percentile":170.7,"90th_percentile":829.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":836.78,"10th_percentile":745.21,"90th_percentile":1470.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":308.0,"10th_percentile":308.0,"90th_percentile":308.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":5135.11,"10th_percentile":4739.94,"90th_percentile":5187.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1112.95,"10th_percentile":890.36,"90th_percentile":1120.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1910.45,"10th_percentile":1698.54,"90th_percentile":2040.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":1610.75,"10th_percentile":1127.65,"90th_percentile":2379.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1061.36,"10th_percentile":615.17,"90th_percentile":1133.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"50","median_amount":6036.3,"10th_percentile":4153.31,"90th_percentile":7141.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":1080.95,"10th_percentile":851.27,"90th_percentile":2066.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5738.36,"10th_percentile":2609.32,"90th_percentile":9360.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4516.11,"10th_percentile":3788.24,"90th_percentile":7841.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":941.99,"10th_percentile":941.99,"90th_percentile":941.99},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":1102.54,"10th_percentile":661.54,"90th_percentile":1182.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3352.84,"10th_percentile":2012.76,"90th_percentile":3725.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":324.94,"10th_percentile":302.4,"90th_percentile":1715.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1061.36,"10th_percentile":1061.36,"90th_percentile":1133.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":294.0,"10th_percentile":289.66,"90th_percentile":1637.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"11","median_amount":5394.9,"10th_percentile":3940.4,"90th_percentile":7851.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":873.72,"10th_percentile":694.65,"90th_percentile":1089.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1193.11,"10th_percentile":1193.11,"90th_percentile":1193.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"50","median_amount":381.91,"10th_percentile":222.11,"90th_percentile":789.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":360.5,"10th_percentile":208.45,"90th_percentile":373.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"37","median_amount":1968.13,"10th_percentile":1196.56,"90th_percentile":4737.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"30","median_amount":391.43,"10th_percentile":193.83,"90th_percentile":615.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":669.19,"10th_percentile":468.43,"90th_percentile":1045.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"88","median_amount":581.69,"10th_percentile":163.21,"90th_percentile":2028.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"49","median_amount":371.77,"10th_percentile":297.42,"90th_percentile":579.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":2253.41,"10th_percentile":2253.41,"90th_percentile":2253.41},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"326","median_amount":2253.09,"10th_percentile":940.11,"90th_percentile":6756.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"203","median_amount":370.75,"10th_percentile":225.32,"90th_percentile":1780.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"38","median_amount":2141.88,"10th_percentile":449.53,"90th_percentile":6464.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1474.72,"10th_percentile":1474.72,"90th_percentile":1475.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"49","median_amount":1512.9,"10th_percentile":436.0,"90th_percentile":4481.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":67.7,"10th_percentile":67.7,"90th_percentile":67.7},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":339.43,"10th_percentile":330.74,"90th_percentile":1472.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"90","median_amount":392.7,"10th_percentile":67.7,"90th_percentile":748.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":1174.42,"10th_percentile":1109.16,"90th_percentile":1304.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"20","median_amount":353.95,"10th_percentile":314.24,"90th_percentile":1585.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":371.77,"10th_percentile":371.77,"90th_percentile":774.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":476.99,"10th_percentile":476.99,"90th_percentile":476.99},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.59,"10th_percentile":366.59,"90th_percentile":366.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"38","median_amount":344.11,"10th_percentile":325.89,"90th_percentile":1247.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"44","median_amount":1857.95,"10th_percentile":394.48,"90th_percentile":2414.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"119","median_amount":327.73,"10th_percentile":158.41,"90th_percentile":627.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"17","median_amount":1984.76,"10th_percentile":1502.81,"90th_percentile":2672.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":279.83,"10th_percentile":46.83,"90th_percentile":396.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":510.77,"10th_percentile":350.77,"90th_percentile":1036.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":320.05,"10th_percentile":320.05,"90th_percentile":588.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"23","median_amount":1831.51,"10th_percentile":1380.7,"90th_percentile":2421.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":523.2,"10th_percentile":417.76,"90th_percentile":1497.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":672.3,"10th_percentile":448.2,"90th_percentile":1215.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"70","median_amount":798.96,"10th_percentile":384.95,"90th_percentile":1058.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":498.0,"10th_percentile":425.4,"90th_percentile":1466.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"268","median_amount":2533.68,"10th_percentile":1036.36,"90th_percentile":2932.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"170","median_amount":751.98,"10th_percentile":478.76,"90th_percentile":919.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"24","median_amount":2420.69,"10th_percentile":810.87,"90th_percentile":3017.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":383.8,"10th_percentile":144.25,"90th_percentile":535.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"28","median_amount":2101.71,"10th_percentile":1478.48,"90th_percentile":2257.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":383.8,"10th_percentile":383.8,"90th_percentile":383.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"61","median_amount":523.82,"10th_percentile":199.0,"90th_percentile":608.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":1542.56,"10th_percentile":1485.78,"90th_percentile":1747.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"17","median_amount":315.34,"10th_percentile":315.31,"90th_percentile":577.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":579.46,"10th_percentile":498.0,"90th_percentile":1101.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":647.4,"10th_percentile":647.4,"90th_percentile":647.4},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"19","median_amount":401.51,"10th_percentile":313.19,"90th_percentile":523.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"48","median_amount":2182.52,"10th_percentile":736.93,"90th_percentile":2836.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"58","median_amount":499.51,"10th_percentile":287.07,"90th_percentile":1092.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"13","median_amount":2182.52,"10th_percentile":975.64,"90th_percentile":4225.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":228.2,"10th_percentile":3.9,"90th_percentile":522.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":1230.99,"10th_percentile":1212.96,"90th_percentile":1235.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":243.53,"10th_percentile":243.53,"90th_percentile":243.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":5040.83,"10th_percentile":5040.83,"90th_percentile":5040.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1270.0,"10th_percentile":1220.5,"90th_percentile":1465.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1674.01,"10th_percentile":316.09,"90th_percentile":5365.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"12","median_amount":2493.91,"10th_percentile":2397.26,"90th_percentile":2934.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1207.8,"10th_percentile":966.24,"90th_percentile":1207.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"68","median_amount":4126.59,"10th_percentile":2414.18,"90th_percentile":4895.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"46","median_amount":2043.68,"10th_percentile":1616.7,"90th_percentile":2158.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1350.5,"10th_percentile":1169.79,"90th_percentile":4239.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5953.95,"10th_percentile":5173.27,"90th_percentile":5993.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":446.59,"10th_percentile":446.59,"90th_percentile":446.59},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":422.51,"10th_percentile":422.51,"90th_percentile":430.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"49","median_amount":1211.59,"10th_percentile":936.16,"90th_percentile":1269.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3815.44,"10th_percentile":3179.99,"90th_percentile":4239.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":450.03,"10th_percentile":430.4,"90th_percentile":548.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1207.8,"10th_percentile":1207.8,"90th_percentile":1207.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3350.84,"10th_percentile":3350.84,"90th_percentile":3350.84},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1136.3,"10th_percentile":1136.3,"90th_percentile":1136.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":443.66,"10th_percentile":443.66,"90th_percentile":443.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":3774.34,"10th_percentile":2532.87,"90th_percentile":3790.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"47","median_amount":1010.49,"10th_percentile":905.38,"90th_percentile":1235.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3479.0,"10th_percentile":3396.98,"90th_percentile":3790.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":972.51,"10th_percentile":923.51,"90th_percentile":1273.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":258.68,"10th_percentile":258.68,"90th_percentile":258.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":242.07,"10th_percentile":242.07,"90th_percentile":242.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1602.0,"10th_percentile":1602.0,"90th_percentile":1602.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":656.88,"10th_percentile":656.88,"90th_percentile":656.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4044.3,"10th_percentile":1411.55,"90th_percentile":5728.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":3724.82,"10th_percentile":3724.82,"90th_percentile":3724.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1458.0,"10th_percentile":838.91,"90th_percentile":2029.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6553.61,"10th_percentile":6553.61,"90th_percentile":7837.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1720.16,"10th_percentile":189.33,"90th_percentile":11944.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":457.91,"10th_percentile":369.22,"90th_percentile":661.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"54","median_amount":4017.6,"10th_percentile":1500.0,"90th_percentile":13796.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"42","median_amount":1385.6,"10th_percentile":1035.3,"90th_percentile":10169.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2772.8,"10th_percentile":2772.8,"90th_percentile":3196.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6934.0,"10th_percentile":1314.0,"90th_percentile":6934.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"27","median_amount":481.39,"10th_percentile":383.55,"90th_percentile":4950.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1376.94,"10th_percentile":878.05,"90th_percentile":1619.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":836.15,"10th_percentile":836.15,"90th_percentile":836.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":461.52,"10th_percentile":338.68,"90th_percentile":4953.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":8434.3,"10th_percentile":8434.3,"90th_percentile":8434.3},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":478.91,"10th_percentile":478.91,"90th_percentile":10683.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"15","median_amount":18714.15,"10th_percentile":2906.88,"90th_percentile":25382.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":501.45,"10th_percentile":379.93,"90th_percentile":4423.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":2345.76,"10th_percentile":793.03,"90th_percentile":2345.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":692.87,"10th_percentile":692.87,"90th_percentile":692.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":2666.08,"10th_percentile":1422.02,"90th_percentile":3246.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":13654.54,"10th_percentile":10738.51,"90th_percentile":20955.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":2410.2,"10th_percentile":2252.91,"90th_percentile":3776.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3905.27,"10th_percentile":3905.27,"90th_percentile":3905.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":6461.29,"10th_percentile":5222.35,"90th_percentile":9997.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":2412.25,"10th_percentile":1735.67,"90th_percentile":2985.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":11961.45,"10th_percentile":11961.45,"90th_percentile":16455.0},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"104","median_amount":17371.13,"10th_percentile":11808.54,"90th_percentile":24154.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"54","median_amount":5896.8,"10th_percentile":3580.2,"90th_percentile":10364.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12255.37,"10th_percentile":12228.02,"90th_percentile":13618.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"11","median_amount":6934.0,"10th_percentile":374.0,"90th_percentile":10214.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3681.95,"10th_percentile":3681.95,"90th_percentile":3681.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":2597.86,"10th_percentile":1722.96,"90th_percentile":3585.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":8302.36,"10th_percentile":6063.21,"90th_percentile":14785.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":115.7,"10th_percentile":115.7,"90th_percentile":157.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"53","median_amount":2337.99,"10th_percentile":1850.24,"90th_percentile":3378.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2824.37,"10th_percentile":2824.37,"90th_percentile":2824.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":112.49,"10th_percentile":112.49,"90th_percentile":3456.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"15","median_amount":13062.39,"10th_percentile":11243.72,"90th_percentile":25490.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":2683.1,"10th_percentile":1614.44,"90th_percentile":3478.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":16221.35,"10th_percentile":16221.35,"90th_percentile":16221.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2434.02,"10th_percentile":1948.09,"90th_percentile":2827.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":4543.71,"10th_percentile":2197.02,"90th_percentile":6835.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":8644.87,"10th_percentile":4600.71,"90th_percentile":9461.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":45447.83,"10th_percentile":16606.51,"90th_percentile":48502.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":3937.59,"10th_percentile":1226.55,"90th_percentile":6586.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6427.67,"10th_percentile":5962.88,"90th_percentile":10539.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"42","median_amount":11930.09,"10th_percentile":5208.3,"90th_percentile":16516.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":3469.09,"10th_percentile":1885.2,"90th_percentile":6950.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":33191.46,"10th_percentile":29440.19,"90th_percentile":40383.13},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"116","median_amount":22605.25,"10th_percentile":4702.52,"90th_percentile":42910.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"94","median_amount":10200.44,"10th_percentile":3264.0,"90th_percentile":14783.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"17","median_amount":34102.1,"10th_percentile":6801.91,"90th_percentile":47680.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":442.33,"10th_percentile":107.13,"90th_percentile":6396.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"16","median_amount":36539.0,"10th_percentile":6010.0,"90th_percentile":55308.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"52","median_amount":4347.62,"10th_percentile":1143.2,"90th_percentile":6929.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":11100.05,"10th_percentile":5132.24,"90th_percentile":22290.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":6645.01,"10th_percentile":6645.01,"90th_percentile":6645.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":4870.76,"10th_percentile":2435.38,"90th_percentile":6374.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":10082.23,"10th_percentile":10082.23,"90th_percentile":10082.23},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3289.68,"10th_percentile":2369.57,"90th_percentile":7369.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"26","median_amount":29222.47,"10th_percentile":5888.28,"90th_percentile":58487.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2131.85,"10th_percentile":2131.85,"90th_percentile":2131.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":2740.88,"10th_percentile":525.78,"90th_percentile":6734.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":40732.66,"10th_percentile":2289.42,"90th_percentile":54820.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3662.8,"10th_percentile":1123.5,"90th_percentile":6997.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"39","median_amount":8433.89,"10th_percentile":1141.37,"90th_percentile":11574.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":3157.93,"10th_percentile":3157.93,"90th_percentile":4753.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":33449.94,"10th_percentile":25918.61,"90th_percentile":67992.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"39","median_amount":6878.7,"10th_percentile":2631.96,"90th_percentile":10886.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11479.38,"10th_percentile":1181.01,"90th_percentile":19263.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"29","median_amount":14519.19,"10th_percentile":8954.38,"90th_percentile":23698.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":7243.52,"10th_percentile":2798.79,"90th_percentile":11318.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":10236.53,"10th_percentile":10236.53,"90th_percentile":10236.53},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"122","median_amount":34366.95,"10th_percentile":4799.0,"90th_percentile":54716.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"53","median_amount":10668.18,"10th_percentile":1678.32,"90th_percentile":16825.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14909.89,"10th_percentile":4320.46,"90th_percentile":59815.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":5693.68,"10th_percentile":5693.68,"90th_percentile":5693.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"18","median_amount":29520.0,"10th_percentile":3654.0,"90th_percentile":59040.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2197.26,"10th_percentile":2197.26,"90th_percentile":2197.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"125","median_amount":6503.43,"10th_percentile":889.52,"90th_percentile":11383.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":23832.23,"10th_percentile":17446.9,"90th_percentile":34530.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2373.12,"10th_percentile":115.7,"90th_percentile":6290.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"98","median_amount":6790.8,"10th_percentile":993.1,"90th_percentile":11656.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":11812.0,"10th_percentile":11812.0,"90th_percentile":11812.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11118.51,"10th_percentile":11118.51,"90th_percentile":11118.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7121.33,"10th_percentile":5928.29,"90th_percentile":37745.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"22","median_amount":21228.54,"10th_percentile":1363.71,"90th_percentile":65175.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"75","median_amount":6572.46,"10th_percentile":982.26,"90th_percentile":11662.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":49575.93,"10th_percentile":49575.93,"90th_percentile":61176.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":5905.62,"10th_percentile":1449.93,"90th_percentile":11049.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":8955.66,"10th_percentile":7074.63,"90th_percentile":10676.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":18660.55,"10th_percentile":18660.55,"90th_percentile":18660.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8220.79,"10th_percentile":7297.87,"90th_percentile":12240.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4584.69,"10th_percentile":4584.69,"90th_percentile":5591.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7595.29,"10th_percentile":6393.93,"90th_percentile":9129.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"36","median_amount":40987.77,"10th_percentile":24684.31,"90th_percentile":49057.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"20","median_amount":12329.18,"10th_percentile":7190.79,"90th_percentile":17117.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34303.71,"10th_percentile":34303.71,"90th_percentile":34303.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":107.13,"10th_percentile":107.13,"90th_percentile":107.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":374.0,"10th_percentile":374.0,"90th_percentile":6560.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":4680.57,"10th_percentile":4680.57,"90th_percentile":4680.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8594.14,"10th_percentile":4908.43,"90th_percentile":11216.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":35735.62,"10th_percentile":35735.62,"90th_percentile":35735.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"16","median_amount":10095.73,"10th_percentile":4976.47,"90th_percentile":10872.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":62488.6,"10th_percentile":62488.6,"90th_percentile":62488.6},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":26655.73,"10th_percentile":26655.73,"90th_percentile":26655.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":48337.84,"10th_percentile":42045.3,"90th_percentile":52712.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":7146.86,"10th_percentile":3307.44,"90th_percentile":10636.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":39889.36,"10th_percentile":39889.36,"90th_percentile":39889.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 7 Radiation Therapy","code_information":[{"code":"5627","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7575.35,"10th_percentile":7575.35,"90th_percentile":7575.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12525.55,"10th_percentile":12525.55,"90th_percentile":12525.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7195.37,"10th_percentile":7195.37,"90th_percentile":7195.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":30095.67,"10th_percentile":29071.71,"90th_percentile":30946.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15896.62,"10th_percentile":15680.88,"90th_percentile":16666.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7817.78,"10th_percentile":7817.78,"90th_percentile":7817.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24118.53,"10th_percentile":24118.53,"90th_percentile":24118.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7195.37,"10th_percentile":7195.37,"90th_percentile":7195.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2394.29,"10th_percentile":2394.29,"90th_percentile":2394.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":31498.01,"10th_percentile":31498.01,"90th_percentile":31498.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7670.29,"10th_percentile":7670.29,"90th_percentile":7670.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7483.9,"10th_percentile":7483.9,"90th_percentile":7483.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapeutic Nuclear Medicine","code_information":[{"code":"5661","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":17865.23,"10th_percentile":17865.23,"90th_percentile":17865.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6282.3,"10th_percentile":6282.3,"90th_percentile":6282.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4536.65,"10th_percentile":4536.65,"90th_percentile":4536.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20355.05,"10th_percentile":1133.05,"90th_percentile":24984.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4851.3,"10th_percentile":1295.66,"90th_percentile":5587.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":606.32,"10th_percentile":606.32,"90th_percentile":606.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4360.41,"10th_percentile":4360.41,"90th_percentile":4360.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7232.84,"10th_percentile":7232.84,"90th_percentile":7232.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":5063.62,"10th_percentile":5063.62,"90th_percentile":6843.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6630.52,"10th_percentile":6630.52,"90th_percentile":6630.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"88","median_amount":50.39,"10th_percentile":49.54,"90th_percentile":82.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"76","median_amount":30.39,"10th_percentile":19.9,"90th_percentile":109.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"168","median_amount":385.03,"10th_percentile":190.7,"90th_percentile":889.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"80","median_amount":51.83,"10th_percentile":50.97,"90th_percentile":113.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"117","median_amount":88.97,"10th_percentile":41.02,"90th_percentile":187.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"449","median_amount":115.31,"10th_percentile":70.31,"90th_percentile":308.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"103","median_amount":31.57,"10th_percentile":28.02,"90th_percentile":63.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":325.4,"10th_percentile":312.88,"90th_percentile":325.4},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1693","median_amount":325.4,"10th_percentile":232.03,"90th_percentile":878.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"916","median_amount":98.94,"10th_percentile":64.02,"90th_percentile":296.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"164","median_amount":309.34,"10th_percentile":297.44,"90th_percentile":928.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"61","median_amount":59.98,"10th_percentile":27.5,"90th_percentile":126.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"231","median_amount":114.72,"10th_percentile":102.02,"90th_percentile":344.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"20","median_amount":55.26,"10th_percentile":18.09,"90th_percentile":125.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"222","median_amount":51.35,"10th_percentile":51.35,"90th_percentile":51.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":855.95,"10th_percentile":855.95,"90th_percentile":855.95},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"118","median_amount":163.5,"10th_percentile":143.12,"90th_percentile":210.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"118","median_amount":39.07,"10th_percentile":19.54,"90th_percentile":90.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58.13,"10th_percentile":58.13,"90th_percentile":129.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":49.43,"10th_percentile":49.43,"90th_percentile":49.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":86.67,"10th_percentile":37.23,"90th_percentile":1611.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":41.46,"10th_percentile":41.46,"90th_percentile":41.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":48.44,"10th_percentile":48.44,"90th_percentile":48.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58.13,"10th_percentile":58.13,"90th_percentile":58.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"227","median_amount":46.3,"10th_percentile":28.87,"90th_percentile":138.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"258","median_amount":98.94,"10th_percentile":79.15,"90th_percentile":296.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"160","median_amount":50.39,"10th_percentile":49.54,"90th_percentile":51.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"81","median_amount":98.94,"10th_percentile":84.1,"90th_percentile":296.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":51.83,"10th_percentile":41.46,"90th_percentile":52.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":161.59,"10th_percentile":158.9,"90th_percentile":188.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":195.56,"10th_percentile":153.49,"90th_percentile":214.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"17","median_amount":602.28,"10th_percentile":175.06,"90th_percentile":2553.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":166.25,"10th_percentile":125.06,"90th_percentile":366.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":285.37,"10th_percentile":214.03,"90th_percentile":314.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"46","median_amount":236.35,"10th_percentile":185.62,"90th_percentile":461.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":164.38,"10th_percentile":50.86,"90th_percentile":406.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":625.76,"10th_percentile":625.76,"90th_percentile":628.73},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"161","median_amount":650.8,"10th_percentile":152.4,"90th_percentile":1506.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"110","median_amount":197.88,"10th_percentile":66.3,"90th_percentile":465.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":763.55,"10th_percentile":505.65,"90th_percentile":1795.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":297.0,"10th_percentile":151.86,"90th_percentile":297.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"19","median_amount":628.94,"10th_percentile":388.42,"90th_percentile":1076.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":164.69,"10th_percentile":164.69,"90th_percentile":164.69},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":329.62,"10th_percentile":78.79,"90th_percentile":732.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"40","median_amount":164.69,"10th_percentile":164.69,"90th_percentile":197.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":546.48,"10th_percentile":140.21,"90th_percentile":679.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":137.73,"10th_percentile":102.48,"90th_percentile":265.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186.44,"10th_percentile":186.44,"90th_percentile":186.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":158.54,"10th_percentile":158.54,"90th_percentile":167.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":214.93,"10th_percentile":214.93,"90th_percentile":214.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"17","median_amount":166.05,"10th_percentile":73.45,"90th_percentile":326.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"27","median_amount":515.14,"10th_percentile":260.5,"90th_percentile":1094.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"38","median_amount":161.59,"10th_percentile":158.9,"90th_percentile":175.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":515.14,"10th_percentile":385.94,"90th_percentile":1565.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":166.24,"10th_percentile":125.06,"90th_percentile":166.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":339.2,"10th_percentile":339.2,"90th_percentile":457.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":377.96,"10th_percentile":44.99,"90th_percentile":1226.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"16","median_amount":1551.02,"10th_percentile":334.12,"90th_percentile":4836.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"32","median_amount":348.99,"10th_percentile":343.17,"90th_percentile":470.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":551.11,"10th_percentile":452.93,"90th_percentile":749.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"48","median_amount":1089.69,"10th_percentile":174.26,"90th_percentile":1884.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":367.72,"10th_percentile":171.16,"90th_percentile":690.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"243","median_amount":2464.05,"10th_percentile":492.81,"90th_percentile":5255.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"153","median_amount":750.72,"10th_percentile":155.04,"90th_percentile":1749.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":3004.0,"10th_percentile":462.95,"90th_percentile":5242.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1227.95,"10th_percentile":1227.95,"90th_percentile":1286.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"25","median_amount":2109.78,"10th_percentile":479.45,"90th_percentile":3192.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":92.53,"10th_percentile":92.53,"90th_percentile":92.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"132","median_amount":345.72,"10th_percentile":345.72,"90th_percentile":417.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":5056.54,"10th_percentile":5056.54,"90th_percentile":5056.54},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":1158.16,"10th_percentile":460.8,"90th_percentile":1851.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"29","median_amount":189.49,"10th_percentile":73.79,"90th_percentile":913.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":332.81,"10th_percentile":332.81,"90th_percentile":504.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":432.65,"10th_percentile":432.65,"90th_percentile":432.65},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":279.19,"10th_percentile":279.19,"90th_percentile":279.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":626.99,"10th_percentile":626.99,"90th_percentile":626.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"26","median_amount":499.56,"10th_percentile":86.17,"90th_percentile":1649.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"42","median_amount":1331.52,"10th_percentile":327.49,"90th_percentile":2819.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"77","median_amount":339.2,"10th_percentile":333.55,"90th_percentile":393.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"11","median_amount":764.7,"10th_percentile":418.33,"90th_percentile":1775.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":348.99,"10th_percentile":348.99,"90th_percentile":871.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Pathology","code_information":[{"code":"5674","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5345.22,"10th_percentile":4670.47,"90th_percentile":6866.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1938.27,"10th_percentile":1938.27,"90th_percentile":1938.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2673.75,"10th_percentile":2673.75,"90th_percentile":2673.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":7204.23,"10th_percentile":7204.23,"90th_percentile":7204.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":28563.12,"10th_percentile":28563.12,"90th_percentile":28563.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1012.42,"10th_percentile":1012.42,"90th_percentile":1012.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3242.41,"10th_percentile":3242.41,"90th_percentile":3242.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6250.11,"10th_percentile":6250.11,"90th_percentile":6250.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4732.71,"10th_percentile":4732.71,"90th_percentile":4732.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11342.23,"10th_percentile":6683.52,"90th_percentile":26069.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6355.14,"10th_percentile":6355.14,"90th_percentile":6711.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5291.05,"10th_percentile":5291.05,"90th_percentile":5291.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2108.87,"10th_percentile":2108.87,"90th_percentile":4470.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2056.73,"10th_percentile":2056.73,"90th_percentile":2056.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":2631.56,"10th_percentile":2349.24,"90th_percentile":4906.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8280.19,"10th_percentile":8280.19,"90th_percentile":8280.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2353.09,"10th_percentile":2353.09,"90th_percentile":4493.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4789.49,"10th_percentile":4789.49,"90th_percentile":4789.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":2397.21,"10th_percentile":2397.21,"90th_percentile":6863.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":9754.63,"10th_percentile":8633.25,"90th_percentile":10582.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":2591.81,"10th_percentile":1118.86,"90th_percentile":2763.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":9376.66,"10th_percentile":9376.66,"90th_percentile":9376.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":905.18,"10th_percentile":449.37,"90th_percentile":1177.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":581.08,"10th_percentile":549.72,"90th_percentile":3534.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":2402.15,"10th_percentile":2283.86,"90th_percentile":41264.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":817.02,"10th_percentile":817.02,"90th_percentile":1211.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":422.1,"10th_percentile":53.37,"90th_percentile":7683.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":494.45,"10th_percentile":107.13,"90th_percentile":2688.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":879.66,"10th_percentile":366.82,"90th_percentile":1150.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1786.72,"10th_percentile":1786.72,"90th_percentile":1786.72},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"82","median_amount":1244.63,"10th_percentile":430.14,"90th_percentile":9762.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"37","median_amount":402.87,"10th_percentile":120.28,"90th_percentile":2193.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":654.2,"10th_percentile":510.89,"90th_percentile":1264.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":525.58,"10th_percentile":499.74,"90th_percentile":1611.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"17","median_amount":374.0,"10th_percentile":20.0,"90th_percentile":29494.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":276.94,"10th_percentile":276.94,"90th_percentile":276.94},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":200.69,"10th_percentile":43.4,"90th_percentile":1102.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":913.79,"10th_percentile":118.63,"90th_percentile":1199.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":913.62,"10th_percentile":196.46,"90th_percentile":3504.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"22","median_amount":96.36,"10th_percentile":18.15,"90th_percentile":207.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":998.36,"10th_percentile":369.3,"90th_percentile":3481.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":524.74,"10th_percentile":296.03,"90th_percentile":1142.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":333.99,"10th_percentile":186.58,"90th_percentile":2164.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":1125.1,"10th_percentile":946.27,"90th_percentile":1125.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":1455.56,"10th_percentile":1455.56,"90th_percentile":1455.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1038.48,"10th_percentile":1038.48,"90th_percentile":1038.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":894.45,"10th_percentile":194.93,"90th_percentile":2541.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"26","median_amount":821.08,"10th_percentile":211.37,"90th_percentile":1611.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"27","median_amount":2539.46,"10th_percentile":383.61,"90th_percentile":7174.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"40","median_amount":993.66,"10th_percentile":204.91,"90th_percentile":3183.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"59","median_amount":887.39,"10th_percentile":278.71,"90th_percentile":2010.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"85","median_amount":1421.2,"10th_percentile":297.97,"90th_percentile":3832.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"64","median_amount":755.55,"10th_percentile":194.93,"90th_percentile":2339.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":5559.06,"10th_percentile":5559.06,"90th_percentile":5559.06},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"360","median_amount":2904.22,"10th_percentile":966.56,"90th_percentile":6584.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"156","median_amount":601.99,"10th_percentile":187.11,"90th_percentile":2608.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":3744.73,"10th_percentile":2042.08,"90th_percentile":7029.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"30","median_amount":723.77,"10th_percentile":197.27,"90th_percentile":2758.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"55","median_amount":1786.67,"10th_percentile":374.0,"90th_percentile":4690.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1070.6,"10th_percentile":1070.6,"90th_percentile":1070.6},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":406.75,"10th_percentile":243.18,"90th_percentile":1249.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"162","median_amount":676.01,"10th_percentile":203.32,"90th_percentile":1399.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"53","median_amount":1691.92,"10th_percentile":684.2,"90th_percentile":3702.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"76","median_amount":238.37,"10th_percentile":87.05,"90th_percentile":861.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1136.78,"10th_percentile":1136.78,"90th_percentile":1136.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"37","median_amount":1150.33,"10th_percentile":878.95,"90th_percentile":2080.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1922.59,"10th_percentile":1922.59,"90th_percentile":4393.81},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":983.42,"10th_percentile":983.42,"90th_percentile":983.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1191.69,"10th_percentile":965.02,"90th_percentile":2596.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1000.52,"10th_percentile":447.12,"90th_percentile":1132.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"93","median_amount":770.82,"10th_percentile":283.46,"90th_percentile":1542.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"83","median_amount":808.64,"10th_percentile":285.75,"90th_percentile":4040.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":613.9,"10th_percentile":613.9,"90th_percentile":613.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"175","median_amount":909.93,"10th_percentile":197.67,"90th_percentile":2575.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3103.79,"10th_percentile":1079.87,"90th_percentile":3569.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":547.65,"10th_percentile":205.24,"90th_percentile":1595.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2464.71,"10th_percentile":2003.24,"90th_percentile":3511.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":430.01,"10th_percentile":430.01,"90th_percentile":476.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":1133.26,"10th_percentile":1066.4,"90th_percentile":1141.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":148.03,"10th_percentile":123.03,"90th_percentile":148.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":243.53,"10th_percentile":243.53,"90th_percentile":491.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"29","median_amount":575.75,"10th_percentile":318.91,"90th_percentile":575.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":154.18,"10th_percentile":45.18,"90th_percentile":154.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":256.21,"10th_percentile":130.27,"90th_percentile":260.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"84","median_amount":509.44,"10th_percentile":227.95,"90th_percentile":529.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":144.75,"10th_percentile":115.8,"90th_percentile":144.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"353","median_amount":676.69,"10th_percentile":397.49,"90th_percentile":720.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"196","median_amount":338.9,"10th_percentile":227.87,"90th_percentile":453.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"25","median_amount":658.26,"10th_percentile":412.41,"90th_percentile":658.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":221.39,"10th_percentile":221.39,"90th_percentile":221.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"37","median_amount":432.34,"10th_percentile":330.0,"90th_percentile":540.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":122.24,"10th_percentile":122.24,"90th_percentile":122.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":150.37,"10th_percentile":150.37,"90th_percentile":151.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":682.55,"10th_percentile":682.55,"90th_percentile":682.55},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":457.26,"10th_percentile":428.99,"90th_percentile":508.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"23","median_amount":132.02,"10th_percentile":132.02,"90th_percentile":132.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.75,"10th_percentile":144.75,"90th_percentile":144.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":202.65,"10th_percentile":202.65,"90th_percentile":803.0},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"34","median_amount":128.35,"10th_percentile":128.35,"90th_percentile":128.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"66","median_amount":607.87,"10th_percentile":214.69,"90th_percentile":607.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":221.39,"10th_percentile":221.39,"90th_percentile":221.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"73","median_amount":147.73,"10th_percentile":103.43,"90th_percentile":148.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"18","median_amount":607.87,"10th_percentile":427.01,"90th_percentile":623.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":152.78,"10th_percentile":78.28,"90th_percentile":154.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":294.13,"10th_percentile":280.16,"90th_percentile":294.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":428.15,"10th_percentile":428.15,"90th_percentile":2003.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"16","median_amount":1525.95,"10th_percentile":400.0,"90th_percentile":2540.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":302.1,"10th_percentile":302.1,"90th_percentile":304.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"22","median_amount":518.58,"10th_percentile":388.93,"90th_percentile":518.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"40","median_amount":529.98,"10th_percentile":369.74,"90th_percentile":873.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"31","median_amount":288.1,"10th_percentile":230.48,"90th_percentile":288.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":1409.4,"10th_percentile":1409.4,"90th_percentile":1409.4},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"163","median_amount":1328.09,"10th_percentile":509.4,"90th_percentile":1610.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"84","median_amount":436.56,"10th_percentile":271.12,"90th_percentile":547.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":1163.89,"10th_percentile":427.67,"90th_percentile":1448.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":389.23,"10th_percentile":389.23,"90th_percentile":1887.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"16","median_amount":1471.62,"10th_percentile":925.21,"90th_percentile":2362.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1981.83,"10th_percentile":1981.83,"90th_percentile":1981.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"54","median_amount":300.28,"10th_percentile":250.28,"90th_percentile":301.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":566.3,"10th_percentile":566.3,"90th_percentile":566.3},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":892.4,"10th_percentile":833.01,"90th_percentile":1011.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"14","median_amount":713.46,"10th_percentile":420.36,"90th_percentile":1813.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":340.19,"10th_percentile":340.19,"90th_percentile":340.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":288.1,"10th_percentile":288.1,"90th_percentile":288.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":720.25,"10th_percentile":720.25,"90th_percentile":720.25},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"16","median_amount":693.64,"10th_percentile":408.69,"90th_percentile":693.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"38","median_amount":1361.09,"10th_percentile":582.72,"90th_percentile":2816.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"61","median_amount":294.63,"10th_percentile":249.53,"90th_percentile":294.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":2072.97,"10th_percentile":1586.26,"90th_percentile":2647.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":303.34,"10th_percentile":302.1,"90th_percentile":325.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":500.83,"10th_percentile":492.79,"90th_percentile":501.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":408.5,"10th_percentile":408.5,"90th_percentile":408.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":1303.66,"10th_percentile":1303.66,"90th_percentile":3473.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":522.23,"10th_percentile":520.73,"90th_percentile":522.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":883.62,"10th_percentile":833.62,"90th_percentile":883.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":908.92,"10th_percentile":814.67,"90th_percentile":1230.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":490.9,"10th_percentile":490.9,"90th_percentile":490.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"104","median_amount":2002.93,"10th_percentile":1334.3,"90th_percentile":3194.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"39","median_amount":778.26,"10th_percentile":530.61,"90th_percentile":1845.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2002.93,"10th_percentile":2002.93,"90th_percentile":2291.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":660.61,"10th_percentile":660.61,"90th_percentile":660.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1746.2,"10th_percentile":968.43,"90th_percentile":3296.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":660.61,"10th_percentile":660.61,"90th_percentile":660.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":512.02,"10th_percentile":353.94,"90th_percentile":520.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1723.06,"10th_percentile":1723.06,"90th_percentile":1723.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":209.47,"10th_percentile":209.47,"90th_percentile":502.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":490.9,"10th_percentile":490.9,"90th_percentile":490.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":203.65,"10th_percentile":203.65,"90th_percentile":454.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":1377.66,"10th_percentile":1244.52,"90th_percentile":4540.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":502.3,"10th_percentile":456.23,"90th_percentile":502.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":1277.13,"10th_percentile":1277.13,"90th_percentile":1277.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":516.25,"10th_percentile":516.25,"90th_percentile":516.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":959.85,"10th_percentile":928.15,"90th_percentile":959.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":243.53,"10th_percentile":243.53,"90th_percentile":243.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":3203.27,"10th_percentile":2075.76,"90th_percentile":3813.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"13","median_amount":989.42,"10th_percentile":892.96,"90th_percentile":989.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1426.37,"10th_percentile":1186.0,"90th_percentile":1694.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"27","median_amount":2511.22,"10th_percentile":1361.56,"90th_percentile":2612.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12","median_amount":941.27,"10th_percentile":753.02,"90th_percentile":941.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"129","median_amount":3441.49,"10th_percentile":1997.43,"90th_percentile":3549.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"84","median_amount":1870.07,"10th_percentile":1698.3,"90th_percentile":2237.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2594.66,"10th_percentile":2475.82,"90th_percentile":3374.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"13","median_amount":221.39,"10th_percentile":221.39,"90th_percentile":221.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3523.83,"10th_percentile":2273.84,"90th_percentile":3945.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":987.8,"10th_percentile":987.8,"90th_percentile":987.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":979.79,"10th_percentile":782.24,"90th_percentile":980.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2973.47,"10th_percentile":2808.28,"90th_percentile":3303.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":623.79,"10th_percentile":593.36,"90th_percentile":2477.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":941.27,"10th_percentile":941.27,"90th_percentile":941.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":242.53,"10th_percentile":242.53,"90th_percentile":242.53},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"38","median_amount":576.87,"10th_percentile":576.87,"90th_percentile":672.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"18","median_amount":3734.32,"10th_percentile":2871.41,"90th_percentile":4756.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":915.25,"10th_percentile":774.86,"90th_percentile":959.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3963.65,"10th_percentile":3963.65,"90th_percentile":4756.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":955.14,"10th_percentile":889.02,"90th_percentile":987.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1439.45,"10th_percentile":1439.45,"90th_percentile":1439.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":798.44,"10th_percentile":144.18,"90th_percentile":4723.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":391.18,"10th_percentile":322.01,"90th_percentile":687.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1924.0,"10th_percentile":1924.0,"90th_percentile":1924.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":158.78,"10th_percentile":158.78,"90th_percentile":158.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":10.12,"10th_percentile":10.12,"90th_percentile":10.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":45.98,"10th_percentile":45.98,"90th_percentile":45.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23.76,"10th_percentile":23.76,"90th_percentile":23.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"45","median_amount":37.01,"10th_percentile":36.4,"90th_percentile":111.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":14.0,"10th_percentile":14.0,"90th_percentile":28.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"24","median_amount":163.48,"10th_percentile":147.13,"90th_percentile":1448.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":38.37,"10th_percentile":35.58,"90th_percentile":221.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":65.36,"10th_percentile":53.14,"90th_percentile":247.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"64","median_amount":55.06,"10th_percentile":10.06,"90th_percentile":55.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"72","median_amount":42.79,"10th_percentile":36.37,"90th_percentile":106.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"179","median_amount":152.4,"10th_percentile":114.3,"90th_percentile":152.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"94","median_amount":46.92,"10th_percentile":37.54,"90th_percentile":46.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14","median_amount":139.3,"10th_percentile":139.3,"90th_percentile":278.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":19.35,"10th_percentile":19.35,"90th_percentile":25.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"29","median_amount":153.4,"10th_percentile":91.24,"90th_percentile":182.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":12.73,"10th_percentile":12.73,"90th_percentile":12.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"151","median_amount":37.73,"10th_percentile":37.72,"90th_percentile":163.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":127.45,"10th_percentile":117.45,"90th_percentile":413.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11","median_amount":13.75,"10th_percentile":13.75,"90th_percentile":13.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57.12,"10th_percentile":57.12,"90th_percentile":57.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"28","median_amount":36.31,"10th_percentile":36.31,"90th_percentile":254.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":50.83,"10th_percentile":50.83,"90th_percentile":50.83},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":52.65,"10th_percentile":52.65,"90th_percentile":52.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"20","median_amount":20.32,"10th_percentile":20.32,"90th_percentile":637.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"27","median_amount":66.86,"10th_percentile":45.98,"90th_percentile":66.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"131","median_amount":37.76,"10th_percentile":37.01,"90th_percentile":299.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":66.86,"10th_percentile":45.98,"90th_percentile":66.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.07,"10th_percentile":37.22,"90th_percentile":43.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"37","median_amount":56.52,"10th_percentile":31.52,"90th_percentile":221.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":223.74,"10th_percentile":223.74,"90th_percentile":296.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"21","median_amount":552.08,"10th_percentile":320.33,"90th_percentile":3754.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"26","median_amount":58.81,"10th_percentile":57.63,"90th_percentile":573.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":98.93,"10th_percentile":59.49,"90th_percentile":165.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"48","median_amount":218.7,"10th_percentile":87.51,"90th_percentile":299.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"47","median_amount":54.96,"10th_percentile":54.96,"90th_percentile":54.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"242","median_amount":556.2,"10th_percentile":241.55,"90th_percentile":895.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"119","median_amount":118.82,"10th_percentile":63.86,"90th_percentile":213.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":549.89,"10th_percentile":105.48,"90th_percentile":1794.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":660.61,"10th_percentile":660.61,"90th_percentile":660.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"38","median_amount":514.23,"10th_percentile":315.64,"90th_percentile":3523.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":156.74,"10th_percentile":78.37,"90th_percentile":660.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"97","median_amount":58.26,"10th_percentile":57.29,"90th_percentile":549.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":3115.42,"10th_percentile":3115.42,"90th_percentile":3115.42},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":173.62,"10th_percentile":144.7,"90th_percentile":303.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"28","median_amount":320.98,"10th_percentile":196.68,"90th_percentile":713.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":64.89,"10th_percentile":64.89,"90th_percentile":64.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":500.0},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":109.92,"10th_percentile":54.96,"90th_percentile":604.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":64.63,"10th_percentile":64.63,"90th_percentile":64.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"39","median_amount":213.38,"10th_percentile":191.22,"90th_percentile":693.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"34","median_amount":1532.26,"10th_percentile":192.44,"90th_percentile":3963.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"93","median_amount":56.92,"10th_percentile":20.92,"90th_percentile":497.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":283.0,"10th_percentile":283.0,"90th_percentile":440.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":57.87,"10th_percentile":8.63,"90th_percentile":58.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"24","median_amount":121.96,"10th_percentile":121.55,"90th_percentile":124.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"93","median_amount":344.68,"10th_percentile":181.36,"90th_percentile":428.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"15","median_amount":557.11,"10th_percentile":507.5,"90th_percentile":24742.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":125.06,"10th_percentile":116.87,"90th_percentile":176.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"89","median_amount":525.98,"10th_percentile":188.14,"90th_percentile":700.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"60","median_amount":118.25,"10th_percentile":70.35,"90th_percentile":323.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"39","median_amount":119.26,"10th_percentile":15.75,"90th_percentile":119.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"156","median_amount":581.3,"10th_percentile":255.11,"90th_percentile":1558.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"86","median_amount":178.86,"10th_percentile":48.12,"90th_percentile":326.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"85","median_amount":253.44,"10th_percentile":130.26,"90th_percentile":263.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"100","median_amount":248.42,"10th_percentile":60.39,"90th_percentile":377.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"19","median_amount":522.92,"10th_percentile":51.86,"90th_percentile":30788.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"36","median_amount":325.86,"10th_percentile":188.59,"90th_percentile":510.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"78","median_amount":124.01,"10th_percentile":74.89,"90th_percentile":158.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"64","median_amount":961.61,"10th_percentile":376.74,"90th_percentile":1191.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"163","median_amount":303.29,"10th_percentile":170.48,"90th_percentile":430.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":112.2,"10th_percentile":112.2,"90th_percentile":112.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":500.0},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"29","median_amount":119.26,"10th_percentile":119.26,"90th_percentile":119.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":244.8,"10th_percentile":244.8,"90th_percentile":244.8},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":125.57,"10th_percentile":125.57,"90th_percentile":125.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":140.82,"10th_percentile":140.82,"90th_percentile":140.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"264","median_amount":296.18,"10th_percentile":149.23,"90th_percentile":421.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"43","median_amount":333.44,"10th_percentile":31.5,"90th_percentile":588.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"61","median_amount":121.96,"10th_percentile":119.93,"90th_percentile":220.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":587.43,"10th_percentile":587.43,"90th_percentile":587.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"18","median_amount":125.06,"10th_percentile":100.23,"90th_percentile":176.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Minor Procedures","code_information":[{"code":"5735","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":468.76,"10th_percentile":468.76,"90th_percentile":468.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electronic Analysis of Devices","code_information":[{"code":"5741","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":306.88,"10th_percentile":306.88,"90th_percentile":306.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":218.7,"10th_percentile":109.35,"90th_percentile":218.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27.6,"10th_percentile":27.6,"90th_percentile":137.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"31","median_amount":428.0,"10th_percentile":321.0,"90th_percentile":428.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"15","median_amount":194.82,"10th_percentile":79.82,"90th_percentile":196.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":356.37,"10th_percentile":356.37,"90th_percentile":428.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.57,"10th_percentile":36.57,"90th_percentile":36.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":102.94,"10th_percentile":102.94,"90th_percentile":102.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":196.68,"10th_percentile":196.68,"90th_percentile":196.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":48.3,"10th_percentile":48.3,"90th_percentile":48.3},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":191.22,"10th_percentile":191.22,"90th_percentile":191.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":949.84,"10th_percentile":593.65,"90th_percentile":1543.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":271.02,"10th_percentile":180.68,"90th_percentile":813.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"16","median_amount":2108.67,"10th_percentile":872.79,"90th_percentile":2870.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":460.64,"10th_percentile":230.32,"90th_percentile":1266.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":209.68,"10th_percentile":209.68,"90th_percentile":209.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"18","median_amount":753.42,"10th_percentile":130.64,"90th_percentile":1381.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":465.96,"10th_percentile":116.49,"90th_percentile":1164.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"117","median_amount":2445.66,"10th_percentile":671.9,"90th_percentile":4192.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"65","median_amount":673.2,"10th_percentile":224.4,"90th_percentile":1338.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1277.44,"10th_percentile":1277.44,"90th_percentile":1277.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"19","median_amount":1799.63,"10th_percentile":925.52,"90th_percentile":3342.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"56","median_amount":850.57,"10th_percentile":243.02,"90th_percentile":1336.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3438.0,"10th_percentile":3438.0,"90th_percentile":3820.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":27.69,"10th_percentile":27.69,"90th_percentile":27.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":815.43,"10th_percentile":582.45,"90th_percentile":1630.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1968.72,"10th_percentile":1968.72,"90th_percentile":1968.72},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":922.72,"10th_percentile":922.72,"90th_percentile":922.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":603.61,"10th_percentile":344.92,"90th_percentile":689.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"11","median_amount":1266.75,"10th_percentile":289.17,"90th_percentile":3180.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"73","median_amount":712.38,"10th_percentile":287.7,"90th_percentile":1306.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":2602.57,"10th_percentile":873.69,"90th_percentile":3759.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.75,"10th_percentile":122.75,"90th_percentile":122.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"21","median_amount":722.39,"10th_percentile":345.15,"90th_percentile":1306.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":6084.93,"10th_percentile":6084.93,"90th_percentile":6084.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"17","median_amount":1333.03,"10th_percentile":772.35,"90th_percentile":1444.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1228.22,"10th_percentile":1228.22,"90th_percentile":2127.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1582.93,"10th_percentile":720.93,"90th_percentile":2864.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":953.0,"10th_percentile":388.36,"90th_percentile":1288.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"70","median_amount":9111.24,"10th_percentile":3726.73,"90th_percentile":10258.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"36","median_amount":1957.51,"10th_percentile":1501.1,"90th_percentile":2437.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5283.36,"10th_percentile":5283.36,"90th_percentile":8965.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8440.39,"10th_percentile":6398.02,"90th_percentile":12511.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"49","median_amount":1197.8,"10th_percentile":734.73,"90th_percentile":1538.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4109.23,"10th_percentile":4109.23,"90th_percentile":4109.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":1793.17,"10th_percentile":1793.17,"90th_percentile":1793.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1280.84,"10th_percentile":702.34,"90th_percentile":1925.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":740.86,"10th_percentile":740.86,"90th_percentile":740.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"11","median_amount":5355.64,"10th_percentile":328.72,"90th_percentile":6854.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"59","median_amount":871.55,"10th_percentile":364.45,"90th_percentile":1321.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3478.56,"10th_percentile":2748.34,"90th_percentile":4868.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1340.79,"10th_percentile":732.12,"90th_percentile":1361.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.96,"10th_percentile":121.96,"90th_percentile":121.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":492.83,"10th_percentile":259.88,"90th_percentile":549.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":3176.93,"10th_percentile":3176.93,"90th_percentile":3176.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":533.74,"10th_percentile":533.74,"90th_percentile":533.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":338.71,"10th_percentile":338.71,"90th_percentile":338.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":150.0,"10th_percentile":150.0,"90th_percentile":150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":239.53,"10th_percentile":239.53,"90th_percentile":239.53},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"11","median_amount":1076.56,"10th_percentile":249.11,"90th_percentile":2403.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"16","median_amount":513.79,"10th_percentile":241.45,"90th_percentile":971.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":543.84,"10th_percentile":543.84,"90th_percentile":543.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3404.27,"10th_percentile":3404.27,"90th_percentile":3404.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":546.23,"10th_percentile":546.23,"90th_percentile":546.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":440.37,"10th_percentile":382.5,"90th_percentile":531.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":958.57,"10th_percentile":958.57,"90th_percentile":1021.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":539.72,"10th_percentile":539.72,"90th_percentile":737.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":561.59,"10th_percentile":561.59,"90th_percentile":731.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":602.03,"10th_percentile":602.03,"90th_percentile":602.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"19","median_amount":524.74,"10th_percentile":356.2,"90th_percentile":690.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":2090.41,"10th_percentile":2090.41,"90th_percentile":2591.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":816.02,"10th_percentile":816.02,"90th_percentile":2496.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyrotropin injection","code_information":[{"code":"9108","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2784.63,"10th_percentile":2784.63,"90th_percentile":2784.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1374.14,"10th_percentile":1374.14,"90th_percentile":1374.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"RBC leukocytes reduced","code_information":[{"code":"9512","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":310.66,"10th_percentile":310.66,"90th_percentile":310.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11591.14,"10th_percentile":11591.14,"90th_percentile":11591.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4245.18,"10th_percentile":4245.18,"90th_percentile":4245.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":603.6,"10th_percentile":603.6,"90th_percentile":603.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Platelets pheresis path redu","code_information":[{"code":"9536","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1039.94,"10th_percentile":1039.94,"90th_percentile":1039.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1584.35,"10th_percentile":1584.35,"90th_percentile":2203.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5410.97,"10th_percentile":5410.97,"90th_percentile":5410.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2969.96,"10th_percentile":2969.96,"90th_percentile":2969.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"19","median_amount":6900.8,"10th_percentile":912.64,"90th_percentile":8642.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1666.29,"10th_percentile":1666.29,"90th_percentile":1666.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":446.82,"10th_percentile":446.82,"90th_percentile":446.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2620.15,"10th_percentile":2620.15,"90th_percentile":2901.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"102","median_amount":189.33,"10th_percentile":112.49,"90th_percentile":238.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":281.0,"10th_percentile":281.0,"90th_percentile":383.32},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"460","median_amount":281.0,"10th_percentile":227.9,"90th_percentile":383.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"288","median_amount":72.84,"10th_percentile":58.27,"90th_percentile":115.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"32","median_amount":277.75,"10th_percentile":277.75,"90th_percentile":350.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"45","median_amount":370.27,"10th_percentile":281.0,"90th_percentile":374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":107.13,"10th_percentile":107.13,"90th_percentile":107.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":338.3,"10th_percentile":338.3,"90th_percentile":338.3},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"61","median_amount":115.7,"10th_percentile":115.7,"90th_percentile":115.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":238.85,"10th_percentile":238.85,"90th_percentile":338.3},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"85","median_amount":151.0,"10th_percentile":151.0,"90th_percentile":157.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"18","median_amount":151.0,"10th_percentile":151.0,"90th_percentile":151.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"9773","median_amount":32.35,"10th_percentile":8.63,"90th_percentile":89.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"3054","median_amount":41.21,"10th_percentile":11.45,"90th_percentile":179.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1396","median_amount":119.74,"10th_percentile":108.98,"90th_percentile":362.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"7577","median_amount":33.25,"10th_percentile":8.87,"90th_percentile":96.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8.87,"10th_percentile":8.87,"90th_percentile":8.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"5684","median_amount":68.8,"10th_percentile":14.53,"90th_percentile":272.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"3325","median_amount":84.18,"10th_percentile":74.37,"90th_percentile":205.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"12453","median_amount":31.72,"10th_percentile":8.46,"90th_percentile":86.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"89","median_amount":317.7,"10th_percentile":119.36,"90th_percentile":898.0},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"14121","median_amount":135.11,"10th_percentile":119.36,"90th_percentile":429.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"8113","median_amount":72.42,"10th_percentile":44.69,"90th_percentile":241.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"8363","median_amount":372.27,"10th_percentile":113.03,"90th_percentile":1006.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"2486","median_amount":34.15,"10th_percentile":9.56,"90th_percentile":143.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1939","median_amount":139.96,"10th_percentile":96.87,"90th_percentile":325.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"12","median_amount":52.98,"10th_percentile":8.79,"90th_percentile":65.24},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1053","median_amount":34.16,"10th_percentile":10.41,"90th_percentile":160.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23807","median_amount":32.96,"10th_percentile":8.79,"90th_percentile":94.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"21","median_amount":173.51,"10th_percentile":138.61,"90th_percentile":399.5},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"5093","median_amount":124.07,"10th_percentile":29.69,"90th_percentile":440.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"5513","median_amount":43.12,"10th_percentile":11.24,"90th_percentile":167.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"99","median_amount":46.11,"10th_percentile":9.49,"90th_percentile":117.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":74.04,"10th_percentile":31.93,"90th_percentile":488.52},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"240","median_amount":27.48,"10th_percentile":10.26,"90th_percentile":71.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"71","median_amount":86.38,"10th_percentile":34.59,"90th_percentile":399.5},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"146","median_amount":31.0,"10th_percentile":9.1,"90th_percentile":85.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"58","median_amount":24.31,"10th_percentile":7.91,"90th_percentile":78.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"526","median_amount":32.88,"10th_percentile":9.95,"90th_percentile":105.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"11001","median_amount":36.45,"10th_percentile":8.99,"90th_percentile":166.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"2413","median_amount":53.22,"10th_percentile":40.52,"90th_percentile":123.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":429.58,"10th_percentile":429.58,"90th_percentile":429.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20660","median_amount":31.4,"10th_percentile":8.63,"90th_percentile":92.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"692","median_amount":53.22,"10th_percentile":34.22,"90th_percentile":123.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"2435","median_amount":33.82,"10th_percentile":8.87,"90th_percentile":95.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"124","median_amount":203.79,"10th_percentile":70.13,"90th_percentile":394.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"43","median_amount":185.55,"10th_percentile":61.85,"90th_percentile":536.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"84","median_amount":748.56,"10th_percentile":307.01,"90th_percentile":2403.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"105","median_amount":181.24,"10th_percentile":79.37,"90th_percentile":387.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"98","median_amount":346.31,"10th_percentile":117.73,"90th_percentile":778.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"248","median_amount":487.5,"10th_percentile":163.62,"90th_percentile":1274.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"200","median_amount":217.79,"10th_percentile":79.73,"90th_percentile":477.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1128","median_amount":1427.45,"10th_percentile":480.84,"90th_percentile":3855.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"726","median_amount":454.94,"10th_percentile":173.95,"90th_percentile":1103.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"52","median_amount":1500.31,"10th_percentile":540.32,"90th_percentile":3624.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"68","median_amount":205.3,"10th_percentile":112.02,"90th_percentile":493.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"125","median_amount":962.0,"10th_percentile":481.0,"90th_percentile":2526.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"23","median_amount":166.94,"10th_percentile":74.96,"90th_percentile":335.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"259","median_amount":178.56,"10th_percentile":75.37,"90th_percentile":425.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":1099.54,"10th_percentile":1099.54,"90th_percentile":1280.1},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"109","median_amount":681.0,"10th_percentile":245.21,"90th_percentile":1520.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"93","median_amount":161.46,"10th_percentile":60.72,"90th_percentile":384.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":282.84,"10th_percentile":208.76,"90th_percentile":483.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"20","median_amount":159.01,"10th_percentile":75.17,"90th_percentile":427.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":402.12,"10th_percentile":402.12,"90th_percentile":402.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"182","median_amount":137.31,"10th_percentile":59.04,"90th_percentile":412.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"170","median_amount":620.0,"10th_percentile":279.0,"90th_percentile":1841.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":224.55,"10th_percentile":224.55,"90th_percentile":884.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"331","median_amount":183.81,"10th_percentile":73.87,"90th_percentile":403.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"33","median_amount":620.0,"10th_percentile":260.0,"90th_percentile":1550.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":166.26,"10th_percentile":83.13,"90th_percentile":489.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"256","median_amount":105.01,"10th_percentile":105.01,"90th_percentile":105.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"30","median_amount":116.47,"10th_percentile":116.47,"90th_percentile":116.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"173","median_amount":380.73,"10th_percentile":368.14,"90th_percentile":411.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"239","median_amount":108.03,"10th_percentile":95.93,"90th_percentile":118.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"127","median_amount":185.46,"10th_percentile":185.46,"90th_percentile":185.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"517","median_amount":153.99,"10th_percentile":143.37,"90th_percentile":164.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"376","median_amount":103.03,"10th_percentile":87.57,"90th_percentile":103.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":471.39,"10th_percentile":471.39,"90th_percentile":477.84},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"2097","median_amount":471.39,"10th_percentile":146.32,"90th_percentile":477.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"2666","median_amount":146.32,"10th_percentile":146.32,"90th_percentile":259.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"253","median_amount":446.71,"10th_percentile":431.01,"90th_percentile":481.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"12","median_amount":105.88,"10th_percentile":105.88,"90th_percentile":105.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"275","median_amount":531.0,"10th_percentile":531.0,"90th_percentile":580.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":105.88,"10th_percentile":105.88,"90th_percentile":157.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"740","median_amount":107.04,"10th_percentile":107.04,"90th_percentile":117.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":451.35,"10th_percentile":451.35,"90th_percentile":451.35},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"76","median_amount":361.63,"10th_percentile":361.63,"90th_percentile":361.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"52","median_amount":114.35,"10th_percentile":114.35,"90th_percentile":114.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":121.16,"10th_percentile":121.16,"90th_percentile":121.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":488.52,"10th_percentile":488.52,"90th_percentile":488.52},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":103.03,"10th_percentile":103.03,"90th_percentile":103.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"14","median_amount":329.65,"10th_percentile":133.94,"90th_percentile":451.35},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":108.03,"10th_percentile":108.03,"90th_percentile":108.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":121.16,"10th_percentile":121.16,"90th_percentile":121.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"101","median_amount":111.18,"10th_percentile":111.18,"90th_percentile":111.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"425","median_amount":364.0,"10th_percentile":364.0,"90th_percentile":379.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":558.58,"10th_percentile":558.58,"90th_percentile":558.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"675","median_amount":105.01,"10th_percentile":105.01,"90th_percentile":114.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"99","median_amount":364.0,"10th_percentile":364.0,"90th_percentile":379.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"59","median_amount":108.03,"10th_percentile":108.03,"90th_percentile":109.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Durable Medical Equipment","code_information":[{"code":"N805","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"36","median_amount":280.04,"10th_percentile":54.03,"90th_percentile":614.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":239.25,"10th_percentile":95.7,"90th_percentile":406.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":216.0,"10th_percentile":65.0,"90th_percentile":1306.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"15","median_amount":177.13,"10th_percentile":55.59,"90th_percentile":885.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":358.78,"10th_percentile":358.78,"90th_percentile":358.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.0,"10th_percentile":144.0,"90th_percentile":144.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"36","median_amount":193.55,"10th_percentile":51.62,"90th_percentile":825.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"48","median_amount":211.16,"10th_percentile":52.79,"90th_percentile":600.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"82","median_amount":255.92,"10th_percentile":65.0,"90th_percentile":1034.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"99","median_amount":153.55,"10th_percentile":63.72,"90th_percentile":617.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":224.06,"10th_percentile":130.0,"90th_percentile":783.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":87.0,"10th_percentile":43.5,"90th_percentile":413.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"14","median_amount":351.98,"10th_percentile":91.44,"90th_percentile":791.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"70","median_amount":207.78,"10th_percentile":51.95,"90th_percentile":544.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":146.25,"10th_percentile":65.0,"90th_percentile":653.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":634.13,"10th_percentile":634.13,"90th_percentile":634.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":724.62,"10th_percentile":724.62,"90th_percentile":724.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":182.7,"10th_percentile":45.68,"90th_percentile":867.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"15","median_amount":158.56,"10th_percentile":39.64,"90th_percentile":419.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27.65,"10th_percentile":27.65,"90th_percentile":117.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"101","median_amount":174.0,"10th_percentile":53.81,"90th_percentile":564.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":79.28,"10th_percentile":79.28,"90th_percentile":340.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":332.03,"10th_percentile":132.86,"90th_percentile":833.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":1277.68,"10th_percentile":1277.68,"90th_percentile":1868.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":122.39,"10th_percentile":122.39,"90th_percentile":122.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":756.17,"10th_percentile":756.17,"90th_percentile":756.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":193.65,"10th_percentile":66.64,"90th_percentile":363.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"19","median_amount":1116.7,"10th_percentile":408.94,"90th_percentile":1852.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":352.02,"10th_percentile":229.37,"90th_percentile":546.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":985.25,"10th_percentile":481.0,"90th_percentile":1370.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":168.98,"10th_percentile":168.98,"90th_percentile":168.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":112.4,"10th_percentile":112.4,"90th_percentile":112.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":198.43,"10th_percentile":159.52,"90th_percentile":288.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":744.0,"10th_percentile":744.0,"90th_percentile":744.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"11","median_amount":139.27,"10th_percentile":80.56,"90th_percentile":309.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"68","median_amount":100.77,"10th_percentile":79.1,"90th_percentile":124.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":184.39,"10th_percentile":146.38,"90th_percentile":184.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"74","median_amount":371.4,"10th_percentile":271.01,"90th_percentile":498.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"23","median_amount":170.42,"10th_percentile":116.7,"90th_percentile":233.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"173","median_amount":150.22,"10th_percentile":65.0,"90th_percentile":186.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":77.61,"10th_percentile":77.61,"90th_percentile":98.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"1 through 10","median_amount":443.08,"10th_percentile":355.34,"90th_percentile":493.08},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"517","median_amount":366.39,"10th_percentile":234.46,"90th_percentile":469.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":167.62,"10th_percentile":167.62,"90th_percentile":167.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"82","median_amount":518.0,"10th_percentile":318.58,"90th_percentile":644.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":167.62,"10th_percentile":167.62,"90th_percentile":167.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"33","median_amount":347.03,"10th_percentile":272.41,"90th_percentile":347.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"21","median_amount":181.03,"10th_percentile":143.72,"90th_percentile":241.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"61","median_amount":244.73,"10th_percentile":223.61,"90th_percentile":244.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":125.39,"10th_percentile":109.79,"90th_percentile":165.03},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":209.38,"10th_percentile":209.38,"90th_percentile":209.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"35","median_amount":176.01,"10th_percentile":139.73,"90th_percentile":176.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"102","median_amount":364.0,"10th_percentile":247.18,"90th_percentile":379.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"25","median_amount":364.0,"10th_percentile":359.4,"90th_percentile":379.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"14","median_amount":83.04,"10th_percentile":81.38,"90th_percentile":103.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":303.86,"10th_percentile":256.5,"90th_percentile":541.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"1 through 10","median_amount":236.81,"10th_percentile":236.81,"90th_percentile":236.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"1 through 10","median_amount":1931.2,"10th_percentile":1931.2,"90th_percentile":1931.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":348.16,"10th_percentile":348.16,"90th_percentile":348.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":71.7,"count":"1 through 10","median_amount":3863.17,"10th_percentile":1903.83,"90th_percentile":4325.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"29","median_amount":1409.4,"10th_percentile":394.29,"90th_percentile":1513.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3564.7,"10th_percentile":3564.7,"90th_percentile":3791.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":625.2,"10th_percentile":625.2,"90th_percentile":2610.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Fee Schedule Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 27801] [Cardiac Cath ($): 21048] [Laminectomy/Diskectomy ($): 32984] [Lap Chole ($): 32984] [PTCA ($): 58466] [Observation ($): 11789] [ED Level 1--99281 ($): 908] [ED Level 2--99282 ($): 908] [ED Level 3--99283 ($): 5582] [ED Level 4--99284 ($): 5582] [ED Level 5--99285 ($): 5582] [Critical Care-99291 ($): 6455] [Urgent Care ($): 403] [Clinic Visit ($): 374] [Chemotherapy ($): 3280] [Radiation Therapy ($): 3280] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis ($): 620] [Peritoneal Dialysis, CAPD, and CCPD ($): 620] [Occupational Therapy ($): 481] [Physical Therapy ($): 481] [Resp. Services/Therapy ($): 540] [Speech Therapy ($): 481] [OP High Cost Drugs ($): FEE SCHEDULE]","count":"19","median_amount":3560.39,"10th_percentile":1700.43,"90th_percentile":3750.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":349.15,"10th_percentile":349.15,"90th_percentile":349.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"1 through 10","median_amount":4860.91,"10th_percentile":4860.91,"90th_percentile":4860.91},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":123.17,"10th_percentile":123.17,"90th_percentile":123.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":394.72,"10th_percentile":394.72,"90th_percentile":394.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"1 through 10","median_amount":28.33,"10th_percentile":28.33,"90th_percentile":28.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 75.70] [Stereotactic Radiosurgery (%BC): 75.70] [Stereotactic Radiosurgery-Fractionated (%BC): 75.70] [Observation ($): 9611] [ED Level 1--99281 ($): 936] [ED Level 2--99282 ($): 936] [ED Level 3--99283 ($): 3909] [ED Level 4--99284 ($): 3909] [ED Level 5--99285 ($): 4964] [Critical Care ($): 4966] [Urgent Care ($): 157] [Clinic Visit ($): 157] [Cardiac Rehabilitation Therapy (%BC): 75.70] [Cardiac Stress Test (%BC): 75.70] [Cardiology (%BC): 75.70] [Echocardiology (%BC): 75.70] [EKG/ECG ($): 294] [Holter Monitor/Telemetry (%BC): 75.70] [Peripheral Vascular Lab (%BC): 75.70] [EEG (%BC): 75.70] [EMG (%BC): 75.70] [MEG (%BC): 75.70] [Neuropsychological Testing and Biofeedback (%BC): 75.70] [Sleep Studies (%BC): 75.70] [Chemotherapy ($): 330] [Nuclear Medicine ($): 2020] [Oncology (%BC): 75.70] [Radiation Therapy  (%BC): 75.70] [CT Scan OP ($): 2704] [MRI OP ($): 3196] [Imaging Services ($): 181] [Mammography-Diagnostic ($): 379] [Mammography-Screening ($): 379] [Positron Emission Tomography ($): 600] [Ultrasound Imaging ($): 728] [Laboratory (%BC): 50] [Laboratory Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 75.70] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 75.70] [Occupational Therapy ($): 322] [Physical Therapy ($): 322] [Respiratory Services/Therapy  (%BC): 75.70] [Speech Therapy ($): 322] [OP High Cost Drugs ($): FEE SCHEDULE] [Other Outpatient Implant (%BC): 50] [Ambulance--Air  (%BC): 75.70] [Ambulance--Land  (%BC): 75.70] [Hyperbarics (%BC): 78.73] [IV Therapy ($): 312] [Pulmonary Function (%BC): 75.70] [Pulmonary Rehabilitation (%BC): 75.70]","count":"28","median_amount":3073.0,"10th_percentile":943.14,"90th_percentile":3199.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 71.2] [Stereotactic Radiosurgery (%BC): 71.2] [Stereotactic Radiosurgery-Fractionated (%BC): 71.2] [Observation (%BC): 71.2] [Emergency Department (%BC): 71.2] [Urgent Care (%BC): 71.2] [Cardiac Rehabilitation Therapy (%BC): 71.2] [Cardiac Stress Test (%BC): 71.2] [Cardiology (%BC): 71.2] [Echocardiology (%BC): 71.2] [EKG/ECG  (%BC): 71.2] [Holter Monitor/Telemetry (%BC): 71.2] [Peripheral Vascular Lab (%BC): 71.2] [EEG (%BC): 71.2] [EMG (%BC): 71.2] [MEG (%BC): 71.2] [Neuropsychological Testing and Biofeedback (%BC): 71.2] [Sleep Studies (%BC): 71.2] [Chemotherapy (%BC): 71.2] [Nuclear Medicine (%BC): 71.2] [Oncology (%BC): 71.2] [Radiation Therapy  (%BC): 71.2] [CT OP Scan (%BC): 71.2] [MRI OP (%BC): 71.2] [Imaging Services (%BC): 71.2] [Mammography-Diagnostic (%BC): 71.2] [Mammography-Screening (%BC): 71.2] [Positron Emission Tomography (%BC): 71.2] [Radiology (%BC): 71.2] [Ultrasound Imaging (%BC): 71.2] [Laboratory (%BC): 71.2] [Pathology (%BC): 71.2] [Hemodialysis (%BC): 71.2] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 71.2] [Occupational Therapy (%BC): 71.2] [Physical Therapy (%BC): 71.2] [Respiratory Services/Therapy  (%BC): 71.2] [Speech Therapy (%BC): 71.2] [Ambulance--Air  (%BC): 71.2] [Ambulance--Land  (%BC): 71.2] [Hyperbarics (%BC): 71.2] [IV Therapy (%BC): 71.2] [Pulmonary Function (%BC): 71.2] [Pulmonary Rehabilitation (%BC): 71.2]","count":"1 through 10","median_amount":3196.31,"10th_percentile":2954.64,"90th_percentile":3221.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21.67,"10th_percentile":21.67,"90th_percentile":21.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":82440.1,"maximum":197856.24,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86562.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88210.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88210.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":197856.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82440.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87386.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":195383.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98928.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":82440.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88210.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":82440.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":98928.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":197856.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":86562.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88210.91,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42165.26,"10th_percentile":42165.26,"90th_percentile":42165.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":42196.43,"maximum":101271.43,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44306.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101271.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42196.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44728.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":100005.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50635.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":42196.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42196.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50635.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":101271.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44306.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45150.18,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18641.41,"maximum":44739.38,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19946.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19946.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44739.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18641.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19759.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44180.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22369.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18641.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19946.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18641.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22369.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44739.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19946.31,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"1 through 10","median_amount":40114.09,"10th_percentile":40114.09,"90th_percentile":40114.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26477.22,"10th_percentile":26477.22,"90th_percentile":26477.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":25930.15,"maximum":62232.36,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27226.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27745.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27745.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62232.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27485.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":61454.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31116.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":25930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27745.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25930.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31116.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":62232.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27226.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27745.26,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"1 through 10","median_amount":34562.22,"10th_percentile":34562.22,"90th_percentile":34562.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17616.67,"10th_percentile":17616.67,"90th_percentile":17616.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":18584.76,"maximum":44603.42,"payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44603.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18584.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19699.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44045.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22301.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"fee schedule","standard_charge_dollar":18584.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18584.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22301.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"fee schedule","standard_charge_dollar":44603.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19514.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19885.69,"additional_payer_notes":"MSDRG Base Rate"}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. Del. 2 day stay-Case Rate: 9274 Days: 2 Additional Days: 3218] [Normal Newborn-Per Diem: 1430] [Lower Level Neonate-Per Diem: 2014] [Higher Level Neonate-Per Diem: 3212] [Severe Level Neonate-per diem: 5371] [All Other IP (%BC): 67.4]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Allwell","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Normal Newborn-Per Diem: 1406.60] [Alcohol/ Chemical Dependency-Per Diem: 1627.69] [Psych-Per Diem: 1627.69]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":95.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Preferred Blue All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1886.81] [Psych-Per Diem: 1886.61]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"State All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 767]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [Alcohol/ Chemical Dependency-Per Diem: 1805.29] [Psych-Per Diem: 1805.29]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bluechoice","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 95] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 14320 Days: 3] [Normal vag. Del. 2 day stay-Case Rate: 9334 Days: 2] [Normal Newborn-Case Rate: 2456] [Lower level Neonate-Case Rate: 3601] [Higher Level Neonate-Case Rate: 14731] [Severe Level Neonate-Case Rate: 36000] [Transplants-Case Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Choice Care Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Medcost","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Multiplan","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum Va Ccn","plan_name":"Other Noncommercial","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Phcs","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":50.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Absolute Total Care Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"First Choice Vip Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Prime Healthcare","plan_name":"Molina Dual Options Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Select Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 8653] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 16619 Days: 4 Additional Days: 4326] [Normal vag. Del. 2 day stay-Case Rate: 12222 Days: 2 Additional Days: 4326] [Nursery  Level 1- Boarder-Per Diem: 1723] [Nursery  Level 2-Per Diem: 2426] [Nursery  Level 3-Per Diem: 3875] [Nursery  Level 4-NICU-Per Diem: 6160] [Rehab-Per Diem: 2577] [SNF-Per Diem: 3436] [Hospice-Per Diem: 2312]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Marketplace Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > FeeSchedule days | Excess % of Charge: 5703] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 19819 Days: 4 Additional Days: 6333] [Normal vag. Del. 2 day stay-Case Rate: 12528 Days: 2 Additional Days: 4661] [Normal Newborn-Per Diem: 1670] [Lower Level Neonate-Per Diem: 2381] [Higher Level Neonate-Per Diem: 3552] [Severe Level Neonate-per diem: 5952] [Rehab-Per Diem: 2631] [SNF-Per Diem: 2995] [Hospice-Per Diem: 2381]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aarp","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Absolute Total Care","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://www.scdhhs.gov/providers/provider-manual-list]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [C-Section 4 day stay-Case Rate: 14226 Days: 4 Additional Days: 4414] [Normal vag. 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